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Hemal S, Krane LS, Richards KA, Liss M, Kader AK, Davis RL. Risk factors for infectious readmissions following radical cystectomy: results from a prospective multicenter dataset. Ther Adv Urol 2016; 8:167-74. [PMID: 27247626 DOI: 10.1177/1756287216636996] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer. This procedure has a high rate of perioperative complications, many of which are infectious in nature. The objective of our study was to evaluate demographic, intrinsic and extrinsic patient variables associated with developing readmission within 30 days due to infectious complications following RC. METHODS We acquired data available from the American College of Surgeons National Surgical Quality Improvement Program. We queried this dataset to identify all patients who underwent RC for muscle-invasive malignant disease (CPT 188.x) in 2012 based on CPT coding. Logistic regression analysis was used to investigate the relationship between preoperative variables and readmissions for infectious complications. RESULTS Of the 961 patients undergoing cystectomy for malignancy, 159 (17%) required readmission for any indications at a median of 16 days (interquartile range 13-22 days) postoperatively. We identified 71 of a total of 159 (45%) readmissions, which were due to infectious complications. Smoking was more prevalent in the patient population readmitted for an infectious complication compared with the patient population readmitted for a non-infectious complication (37% versus 25%; p = 0.03). Using logistic regression analysis smoking was associated with a significant risk for readmission due to an infectious cause (odds ratio 2.28, 95% confidence interval 1.82-2.97, p = 0.02). Readmission due to an infectious etiology was not associated with other perioperative factors including type of urinary diversion, sex, duration of operation, hypertension, or recent weight loss. CONCLUSION Readmission following RC is a common occurrence and infectious complications drive readmission in almost half of the cases. Current smoking was the only independent risk factor for an infectious readmission. Counseling patients in smoking cessation prior to the procedure may provide an avenue for quality improvement to limit readmissions.
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Affiliation(s)
- Sij Hemal
- Wake Forest School of Medicine, Department of Urology, Medical Center Boulevard, Winston Salem, NC 27106, USA
| | - Louis S Krane
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA
| | - Kyle A Richards
- Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Michael Liss
- Department of Urology, University of Texas Health Science Center, San Antonio, TX, USA
| | - A Karim Kader
- Department of Urology, University of California at San Diego, La Jolla, CA, USA
| | - Ronald L Davis
- Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA
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Abstract
The surgical management of pancreatic diseases is rapidly evolving, encompassing advances in evidence-driven selection of patients amenable for surgical therapy, preoperative risk stratification, refinements in the technical conduct of pancreatic operations, and quantification of postoperative morbidity. These advances have resulted in dramatic reductions in mortality following pancreatic surgery, particularly at high-volume pancreatic centers. Surgical decision making is complex, and requires an intimate understanding of disease pathobiology, host physiology, technical considerations, and evolving trends. This article highlights key developments in the contemporary surgical management of pancreatic diseases.
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Affiliation(s)
- Jashodeep Datta
- Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Charles M Vollmer
- Division of Gastrointestinal Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Lovy AJ, Keswani A, Koehler SM, Kim J, Hausman M. Short-Term Complications of Distal Humerus Fractures in Elderly Patients: Open Reduction Internal Fixation Versus Total Elbow Arthroplasty. Geriatr Orthop Surg Rehabil 2016; 7:39-44. [PMID: 26929856 PMCID: PMC4748166 DOI: 10.1177/2151458516630030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The purpose of this study was to evaluate 30-day postoperative complications of open reduction and internal fixation [ORIF] and total elbow arthroplasty [TEA] for the treatment of distal humerus fractures in elderly patients using a validated national database. Methods: Review of the National Surgical Quality Improvement Program (NSQIP) Database identified all elderly patients (>65 years) who underwent TEA or ORIF for the treatment of closed intra-articular distal humerus fractures from 2007 to 2013. Bivariate and multivariate analyses of risk factors for 30-day adverse events as defined by NSQIP between ORIF and TEA groups were assessed using preoperative and intraoperative variables. Results: Among the 176 patients with distal humerus fractures, there were 33 TEA and 143 ORIF. There was no difference in age, medical comorbidities, or functional status. Total elbow arthroplasty was associated with an increased odds of severe adverse event compared to ORIF (odds ratio = 1.57, P = .16), although it did not achieve statistical significance. Infection rate was 0.7% in ORIF and 0.0% in TEA (P = .99). Insulin-dependent diabetes and functional status were significant independent predictors of postoperative adverse events. Operative time (165 minutes vs 140 minutes, P = .06) and postoperative length of stay (3.6 days vs 2.3 days, P = 0.03) were longer for TEA compared to ORIF. Conclusion: Open reduction and internal fixation and TEA have similar 30-day postoperative complications for the treatment of distal humerus fractures among elderly patients. Despite favorable trends for TEA in recent studies, additional clinical results are needed to understand complications and limitation of TEA. Level of evidence: Level III, prognostic study.
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Affiliation(s)
- Andrew J Lovy
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Aakash Keswani
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Steven M Koehler
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Jaehon Kim
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Michael Hausman
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA
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Algattas H, Kimmell KT, Vates GE. Risk of Reoperation for Hemorrhage in Patients After Craniotomy. World Neurosurg 2016; 87:531-9. [DOI: 10.1016/j.wneu.2015.09.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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After Pancreatectomy, the “90 Days from Surgery” Definition Is Superior to the “30 Days from Discharge” Definition for Capture of Clinically Relevant Readmissions. J Gastrointest Surg 2016; 20:77-84; discussion 84. [PMID: 26493976 DOI: 10.1007/s11605-015-2984-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies by different authors have reported their readmission rates after pancreatectomy as either “30 days from discharge” or “90 days from surgery.” The objective of this study was to determine which of these definitions captures the most surgery-related complications. METHODS A prospectively maintained database at a high volume center was queried to identify all individuals who underwent pancreatectomy between 2000 and 2012 for any diagnosis. The data was analyzed at 30 days after discharge and 90 days after operation. The optimal timing for complication reporting was defined as the time point that maximized the capture of surgery-related readmissions and direct major surgical complications while minimizing the capture of disease (cancer)-related readmissions. RESULTS There were 1123 patients included during the study time period. The median age was 63 years old, and 55.6% were male. Operations included 833 (74.2%) pancreaticoduodenectomies, 257 (22.9%) distal pancreatectomies, 18 (1.6%) total pancreatectomies, and 15 (1.3%) central pancreatectomies. Surgery-related readmissions occurred in 248 (22%) individuals, while readmission related to malignant disease progression occurred in 25 (2%) individuals. The 30 days from discharge definition captured 184 surgery-related readmissions and 1 disease-related readmission (sensitivity 0.74, specificity 0.96). The 90 days from surgery definition captured 215 surgery-related readmissions and 1 disease-related readmission (sensitivity 0.87, specificity 0.96). Major surgical complication was the only independent factor associated with readmission not captured by the 30 days from discharge definition (p = 0.002, HR 3.94, 95% CI 1.44–12.22). CONCLUSION The 90 days from surgery definition was superior to the 30 days from discharge definition, especially with regards to readmission related to major surgical complications.
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Ligh CA, Nelson JA, Wink JD, Gerety PA, Fischer JP, Wu LC, Kanchwala SK. An analysis of early oncologic head and neck free flap reoperations from the 2005-2012 ACS-NSQIP dataset. J Plast Surg Hand Surg 2015; 50:85-92. [PMID: 26571114 DOI: 10.3109/2000656x.2015.1106407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There are limited population-based studies that examine perioperative factors that influence postoperative surgical take-backs to the OR following free flap (FF) reconstruction for head/neck cancer extirpation. The purpose of this study was to critically analyse head/neck free flaps (HNFF) captured in the ACS-NSQIP dataset with a specific focus on postoperative complications and the incidence of factors associated with re-operation. METHODS The 2005-2012 ACS-NSQIP datasets were accessed to identify patients undergoing FF reconstruction after a diagnosis of head/neck cancer. Patient demographics, comorbidities, and perioperative risk factors were examined as covariates, and the primary outcome was return to OR within 30 days of surgery. A multivariate regression was performed to determine independent preoperative factors associated with this complication. RESULTS In total, 855 patients underwent FF for head/neck reconstruction most commonly for the Tongue (24.7%) and Mouth/Floor/cavity (25.0%). Of these, 153 patients (17.9%) returned to the OR within 30 days of surgery. Patients in this cohort had higher rates of wound infections and dehiscence (p < 0.01). Medical complications were significantly higher and included pneumonia (12.4% vs 5.0%, p < 0.01), prolonged ventilation (16.3% vs 4.8%, p < 0.01), myocardial infarction (2.6% vs 0.6%, p = 0.017), and sepsis (7.2% vs 3.4%, p = 0.033). Regression analysis demonstrated that visceral flaps (OR = 9.7, p = 0.012) and hypoalbuminemia (OR = 2.4, p = 0.009) were significant predictors of a return to the OR. CONCLUSION Based on data from the nationwide NSQIP dataset, up to 17% of HNFF return to the OR within 30 days. Although this data-set has some significant limitations, these results can cautiously help to improve preoperative patient optimisation and surgical decision-making.
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Affiliation(s)
- Cassandra A Ligh
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Jonas A Nelson
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Jason D Wink
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Patrick A Gerety
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - John P Fischer
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Liza C Wu
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Suhail K Kanchwala
- a Division of Plastic Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
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Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy. World Neurosurg 2015; 84:1372-9. [DOI: 10.1016/j.wneu.2015.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022]
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Qin C, Hackett NJ, Kim JYS. Assessing the safety of outpatient ventral hernia repair: a NSQIP analysis of 7666 patients. Hernia 2015; 19:919-26. [PMID: 26508500 DOI: 10.1007/s10029-015-1426-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Given the paucity of literature on outpatient ventral hernia repair (VHR), and that assessment of the safety of outpatient surgical procedures is becoming an active area of investigation, we have performed a multi-institutional retrospective analysis benchmarking rates of 30-day complications and readmissions and identifying predictive factors for these outcomes. METHODS National surgical quality improvement project data files from 2011 to 2012 were reviewed to collect data on all patients undergoing outpatient VHR during that period. The incidence of 30-day peri-operative complication and unplanned readmission was surveyed. We created a multivariate regression model to identify predictive factors for overall, surgical, and medical complications and unplanned readmissions with proper risk adjustment. RESULTS 30-day complication and readmission rates in outpatient VHR were acceptably low. 3% of the queried outpatients experienced an overall complication, 2.1% a surgical complication, and 1.1% a medical complication. 3.3% of all patients were readmitted within 30 days. Upon multivariate analysis, predictors of overall complications included age, BMI, history of Chronic Obstructive Pulmonary Disease (COPD), and total operation time, predictors of surgical complications included age, BMI, total operation time, predictors of medical complications included total operation time, and predictors of unplanned readmissions included history of COPD, bleeding disorder, American Society of Anesthesiologists Class 3, 4, or 5, total operation time, and use of the laparoscopic technique. CONCLUSION We have demonstrated that the risk of peri-operative morbidity in VHR as granularly defined in our study is low in the outpatient setting. Identification of predictive factors will be important to patient risk stratification.
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Affiliation(s)
- C Qin
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA.
| | - N J Hackett
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA.
| | - J Y S Kim
- Department of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL, 60611, USA.
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Insulin dependence as an independent predictor of perioperative morbidity after ventral hernia repair: a National Surgical Quality Improvement Program analysis of 45,759 patients. Am J Surg 2015; 211:11-7. [PMID: 26542188 DOI: 10.1016/j.amjsurg.2014.08.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/28/2014] [Accepted: 08/29/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although diabetes mellitus has been identified as a predictor of perioperative morbidity after ventral hernia repair (VHR), it is unclear whether insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) confer the same degree of risk. We examined the variable effect of IDDM and NIDDM on 30-day medical and surgical complications after VHR. METHODS We performed a retrospective analysis of patients in the National Surgical Quality Improvement Program database from 2005 to 2012 undergoing VHR. After perioperative variable comparison, regression analysis was performed to determine whether IDDM and/or NIDDM independently predicted increased complications after proper risk adjustment. RESULTS A total of 45,759 patients were identified to have undergone VHR. Of these, 38,026 patients (83.1%) were not diabetic, 5,252 (11.5%) were NIDDM patients, and 2,481 (5.4%) were IDDM patients. After controlling for other risk factors, we found that IDDM independently predicted increased rates of overall, surgical, and medical complications (odds ratio, 1.284, 1.251, 1.263, respectively) in open repair. IDDM independently predicted increased overall and medical complications (odds ratio, 1.997, 1.889, respectively) but not surgical complications in laparoscopic repair. NIDDM was not significantly associated with any complication type in either procedure type. CONCLUSIONS Our present study suggests that much of the perioperative risk associated with diabetes is attributable to IDDM. The effect of IDDM on laparoscopic and open repair is subtly different. IDDM demonstrates increased overall and medical complications in laparoscopic repair and increased overall, medical, and surgical complications in open repair. Of note, IDDM does not independently predict increased risk for surgical complications in laparoscopic repair.
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Tuttle TM, Burke EE. Bilateral Mastectomy: Doubling Down on Complications? Ann Surg Oncol 2015; 22:3407-8. [PMID: 25994211 DOI: 10.1245/s10434-015-4629-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Todd M Tuttle
- Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA.
| | - Erin E Burke
- Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA
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Schwarz L, Bruno M, Parker NH, Prakash L, Mise Y, Lee JE, Vauthey JN, Aloia TA, Conrad C, Fleming JB, Katz MHG. Active Surveillance for Adverse Events Within 90 Days: The Standard for Reporting Surgical Outcomes After Pancreatectomy. Ann Surg Oncol 2015; 22:3522-9. [DOI: 10.1245/s10434-015-4437-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 12/19/2022]
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Bhagwandin SB, Naffouje S, Salti G. Delayed presentation of major complications in patients undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy following hospital discharge. J Surg Oncol 2014; 111:324-7. [PMID: 25557653 DOI: 10.1002/jso.23834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/03/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Shanel B. Bhagwandin
- Department of Surgery; Division of Surgical Oncology; University of Illinois at Chicago Medical Center; Chicago Illinois
| | - Samer Naffouje
- Department of Surgery; Division of Surgical Oncology; University of Illinois at Chicago Medical Center; Chicago Illinois
| | - George Salti
- Department of Surgery; Division of Surgical Oncology; University of Illinois at Chicago Medical Center; Chicago Illinois
- Department of Surgical Oncology; Edward Hospital; Naperville Illinois
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Hagopian TM, Vitiello GA, Hart AM, Perez SD, Pettitt BJ, Sweeney JF. Do medical students in the operating room affect patient care? An analysis of one institution's experience over the past five years. JOURNAL OF SURGICAL EDUCATION 2014; 71:817-824. [PMID: 24931415 DOI: 10.1016/j.jsurg.2014.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/20/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Medical students are active learners in operating rooms during medical school. This observational study seeks to investigate the effect of medical students on operative time and complications. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program was linked to operative records for nonemergent, inpatient general surgery cases at our institution from 1 January 2009 to 1 January 2013. Cases were grouped into 13 distinct procedure groups. Hospital records provided information on the presence of medical students. Demographics, comorbidities, intraoperative variables, and postoperative complications were analyzed. RESULTS Overall, 2481 cases were included. Controlling for wound class, procedure group, and surgeon, medical students were associated with an additional 14 minutes of operative time. No association between medical students and postoperative complications was observed. CONCLUSIONS The educational benefits gained by the presence of medical students do not appear to jeopardize the quality of patient care.
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Affiliation(s)
- Thomas M Hagopian
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gerardo A Vitiello
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Alexandra M Hart
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sebastian D Perez
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara J Pettitt
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John F Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Lee MK, Lewis RS, Strasberg SM, Hall BL, Allendorf JD, Beane JD, Behrman SW, Callery MP, Christein JD, Drebin JA, Epelboym I, He J, Pitt HA, Winslow E, Wolfgang C, Vollmer CM. Defining the post-operative morbidity index for distal pancreatectomy. HPB (Oxford) 2014; 16:915-23. [PMID: 24931404 PMCID: PMC4238858 DOI: 10.1111/hpb.12293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP). METHODS From 2005-2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients. RESULTS ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4-6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy. DISCUSSION This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.
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Affiliation(s)
- Major K Lee
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
| | - Russell S Lewis
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
| | - Steven M Strasberg
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
| | - Bruce L Hall
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
- Department of Surgery, Olin Business School and the Center for Health Policy, Washington University in St. LouisMO, USA
| | - John D Allendorf
- Department of Surgery, Columbia University School of MedicineNew York, NY, USA
| | - Joal D Beane
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - Stephen W Behrman
- Department of Surgery, University of Tennessee Health Science CenterMemphis, TN, USA
| | - Mark P Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
| | - John D Christein
- Department of Surgery, University of Alabama at Birmingham School of MedicineBirmingham, AL, USA
| | - Jeffrey A Drebin
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
| | - Irene Epelboym
- Department of Surgery, Columbia University School of MedicineNew York, NY, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Henry A Pitt
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
- Department of Surgery, Temple University School of MedicinePhiladelphia, PA, USA
| | - Emily Winslow
- Department of Surgery, University of Wisconsin School of MedicineMadison, WI, USA
| | - Christopher Wolfgang
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Charles M Vollmer
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
- Correspondence: Charles M. Vollmer Jr, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA. Tel: +1 215 349 8516. Fax: +1 215 349 8195. E-mail:
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Parikh JA, Beane JD, Kilbane EM, Milgrom DP, Pitt HA. Is American College of Surgeons NSQIP organ space infection a surrogate for pancreatic fistula? J Am Coll Surg 2014; 219:1111-6. [PMID: 25442065 DOI: 10.1016/j.jamcollsurg.2014.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), pancreatic fistula has not been monitored, although organ space infection (OSI) data are collected. Therefore, the purpose of this analysis was to determine the relationship between ACS NSQIP organ space infection and pancreatic fistulas. STUDY DESIGN From 2007 to 2011, 976 pancreatic resection patients were monitored via ACS NSQIP at our institution. From this database, 250 patients were randomly chosen for further analysis. Four patients were excluded because they underwent total pancreatectomy. Data on OSI were gathered prospectively. Data on pancreatic fistulas and other intra-abdominal complications were determined retrospectively. RESULTS Organ space infections (OSIs) were documented in 22 patients (8.9%). Grades B (n = 26) and C (n = 5) pancreatic fistulas occurred in 31 patients (12.4%); grade A fistulas were observed in 38 patients (15.2%). Bile leaks and gastrointestinal (GI) anastomotic leaks each developed in 5 (2.0%) patients. Only 17 of 31 grade B and C pancreatic fistulas (55%), and none of 38 grade A fistulas were classified as OSIs in ACS NSQIP. In addition, only 2 of 5 bile leaks (40%) and 2 of 5 GI anastomotic leaks (40%) were OSIs. Moreover, 3 OSIs were due to bacterial peritonitis, a chyle leak, and an ischemic bowel. CONCLUSIONS This analysis suggests that the sensitivity (55%) and specificity (45%) of organ space infection (OSI) in ACS NSQIP are too low for OSI to be a surrogate for grade B and C pancreatic fistulas. We concluded that procedure-specific variables will be required for ACS NSQIP to improve outcomes after pancreatectomy.
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Affiliation(s)
- Janak Atul Parikh
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Joal D Beane
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - Daniel P Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Henry A Pitt
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA.
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Differential impact of non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus on breast reconstruction outcomes. Breast Cancer Res Treat 2014; 146:429-38. [DOI: 10.1007/s10549-014-3024-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 01/11/2023]
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