Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study

Appendicitis is a common and urgentsurgical illness with protean manifestations,generous overlap with other clinical syndromes,and significant morbidity,whichincreases with diagnostic delay. No single sign,symptom,or diagnostic test accurately confirms the diagnosis ofappendiceal inflammation in all cases. The surgeon's goals are to evaluate a relatively small population of patients referred for suspected appendicitis and to minimize the negative appendectomy rate without increasing the incidence of perforation. The emergency department clinician must evaluate the larger group of patients who present to the ED with abdominal pain of all etiologies with the goal of approaching 100% sensitivity for the diagnosis in a time-,cost-,and consultation-efficient manner.IN 1886Reginald fitz, pathologist 1st described the clinical condition of A.A.Fewyears laterCharles mcBurney describe the clinical finding ofA.A.55% of patients presented with classical symptom of A.A so complication occurbecauseof atypical presentation which due to variation in app. Position, age of patient & degree of inflammation.Migrating pain 80% sensitive and specific Vomiting 50% Nausea60 -90 %Anorexia 75 % Diarrhea18 % 32 % has similar attach 90 % RLQ tenderness Marklesign 74 %Dunphy's sign (sharp pain in the RLQ elicited by a voluntary cough) may be helpful in making the clinical diagnosis of localized peritonitis. Similarly,RLQ pain in response to percussion of a remote quadrant of the abdomen,or to firm percussion of the patient's heel,suggests peritoneal Inflammation

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Correlation of perioperative risk scores with hospital costs in neurosurgical patients

Journal of Neurosurgery ◽

10.3171/2018.10.jns182041 ◽

2020 ◽

Vol 132 (3) ◽

pp. 818-824

Author(s):

Sasha Vaziri ◽

Joseph M. Abbatematteo ◽

Max S. Fleisher ◽

Alexander B. Dru ◽

Dennis T. Lockney ◽

...

Keyword(s):

Surgical Site Infection ◽

Hospital Costs ◽

Patient Characteristics ◽

Risk Scores ◽

Site Infection ◽

Risk Calculator ◽

Surgical Risk ◽

Acs Nsqip ◽

Neurosurgical Patients ◽

Predicted Risk

OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs.METHODSA single-center retrospective review of 1005 neurosurgical patients treated between September 1, 2011, and December 31, 2014, was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs.RESULTSThe Pearson correlation coefficient (R) was used to assess the correlation between 11 types of predicted complication risk scores and 5 types of encounter costs from 1005 health encounters involving neurosurgical procedures. Risk scores in categories such as any complication, serious complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehabilitation facility were obtained. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005).CONCLUSIONSPrevious work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.

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Faculty Opinions recommendation of Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717996327.793473995 ◽

2013 ◽

Author(s):

Thomas Slaughter

Keyword(s):

Cardiac Arrest ◽

Patient Characteristics ◽

Surgical Patients ◽

Acs Nsqip

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Renal Function as a Predictor of Reamputation After Initial Transmetatarsal Amputation in the Perioperative Period

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00017 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0001

Author(s):

Junho Ahn ◽

Katherine Raspovic ◽

Dane Wukich ◽

George Liu

Keyword(s):

Chronic Kidney Disease ◽

Renal Failure ◽

Renal Function ◽

Kidney Disease ◽

Lower Extremity ◽

Perioperative Period ◽

Improvement Program ◽

Acs Nsqip ◽

Cell Counts ◽

Insulin Dependent

Category: Midfoot/Forefoot Introduction/Purpose: With increasing rates of patients being newly diagnosed with diabetes mellitus, foot complications are becoming more common, which often lead to amputation. Compared to major lower extremity amputations, transmetatarsal amputations (TMA) are associated with lower cost, better function, and more aesthetically satisfactory results for patients. Renal failure has been shown to be a significant predictor of morbidity and mortality in lower extremity amputations at various levels. However, previous reports examining the effect of renal function on reamputation rates after TMA have been mixed. As a result, the purpose of this study was to evaluate renal dysfunction as a risk factor for reamputation after initial TMA during the 30-day perioperative period in a large population database. Methods: Patients under 90 years of age who underwent a TMA between 2012 and 2015 were retrospectively identified in the prospectively collected American College of Surgeons-National Surgical Quality Improvement Program® (ACS-NSQIP®) database using the Current Procedure Terminology (CPT) code 28805. Failure of the initial TMA was defined as reamputation in the 30-day perioperative period through corresponding CPT codes. From these criteria, a total of 1,775 patients were identified. More than 150 unique patient factors were included in the study, but glycated hemoglobin (HbA1C) was not reported by the ACS-NSQIP® database. Diabetes status was categorized into four groups: “Insulin” dependent, “Non-Insulin” dependent, or “None.” Filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and patients were categorized into stages of chronic kidney disease (CKD). Results: Over the 30-day perioperative period, the rate of reamputation after TMA was 6.5%. No statistical differences in age, gender, race, body-mass index, or level of pre-operative functional status were found between groups. Reamputation rates after TMA was significantly correlated with higher white blood cell counts (p<.00001), greater serum creatinine (p=.021), higher blood urea nitrogen (p=.021), type of glycemic control (p=.002), stage of CKD (p=.003), dialysis (p=.001), and pre-operative blood transfusion (p=.042). Stage IV-V CKD was associated with 75% increased odds of reamputation (OR=1.75, 95% CI=1.12-2.73), and higher stage of CKD was associated with greater reamputation rates (p=.003) where stage II CKD had the lowest reamputation rate (3.6%) and stage V with the highest reamputation rate (10.9%). A similar trend was seen with 30-day mortality (p<.00001). Conclusion: In the current study, CKD was significantly correlated with reamputation rates after TMA as well as 30-day mortality. In contrast to a previous report, dialysis was also associated with TMA failure and need for reamputation. Our findings corroborate previous findings correlating dialysis-dependent renal failure and mortality. Whether patients in certain stages of CKD would achieve better outcomes with higher-level amputation rather than a TMA should be investigated in future studies.

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Independent Operating by General Surgery Residents: An ACS-NSQIP Analysis

Journal of Surgical Education ◽

10.1016/j.jsurg.2021.03.016 ◽

2021 ◽

Author(s):

Karen J Dickinson ◽

Barbara L Bass ◽

Edward A Graviss ◽

Duc T Nguyen ◽

Kevin Y Pei

Keyword(s):

General Surgery ◽

Acs Nsqip

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Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

Journal of Clinical Medicine ◽

10.3390/jcm10112456 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2456

Author(s):

Raminta Luksaite-Lukste ◽

Ruta Kliokyte ◽

Arturas Samuilis ◽

Eugenijus Jasiunas ◽

Martynas Luksta ◽

...

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Surgical Outcomes ◽

Imaging Modality ◽

Ct Scans ◽

Negative Appendectomy ◽

Transabdominal Ultrasound ◽

First Choice ◽

Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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Economic impact of the use of the National Surgical Quality Improvement Program

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000616 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Alvine Fansi ◽

Angela Ly ◽

Julie Mayrand ◽

Maggy Wassef ◽

Aldanie Rho ◽

...

Keyword(s):

Quality Improvement ◽

Cost Analysis ◽

Economic Impact ◽

Quality Improvement Program ◽

Economic Evaluations ◽

Complication Rates ◽

Improvement Program ◽

Surgical Quality ◽

Acs Nsqip ◽

The Cost

Objectives The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is a validated, risk-adjusted database for improving the quality and security of surgical care. ACS NSQIP can help participating hospitals target areas that need improvement. The aim of this study was to systematically review the literature analyzing the economic impact of using NSQIP. This paper also provides an estimation of annual cost savings following the implementation of NSQIP and quality improvement (QI) activities in two hospitals in Quebec. Methods In June 2018, we searched in seven databases, including PubMed, Embase, and NHSEED for economic evaluations based on NSQIP data. Contextual NSQIP databases from two hospitals were collected and analyzed. A cost analysis was conducted from the hospital care perspective, comparing complication costs before and after 1 year of the implementation of NSQIP and QI activities. The number and the cost of complications are measured. Costs are presented in 2018 Canadian dollars. Results Out of 1,612 studies, 11 were selected. The level of overall evidence was judged to be of moderate to high quality. In general, data showed that, following the implementation of NSQIP and QI activities, a significant decrease in complications and associated costs was observed, which improved with time. In the cost analysis of contextual data, the reduction in complication costs outweighed the cost of implementing NSQIP. However, this cost analysis did not take into account the costs of QI activities. Conclusions NSQIP improves complication rates and associated costs when QI activities are implemented.

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