Peripheral Nerve Injury during Abdominal-Pelvic Surgery: Analysis of the National Surgical Quality Improvement Program Database

2017 ◽  
Vol 83 (11) ◽  
pp. 1214-1219 ◽  
Author(s):  
Christopher J.D. Wallis ◽  
Sarah Peltz ◽  
James Byrne ◽  
Jamie Kroft ◽  
Paul Karanicolas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Peripheral Nerve Injury ◽  
Odds Ratio ◽  
Open Surgery ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
Preventable Complication

Peripheral nerve injury (PNI) is a rare but preventable complication of surgery. We sought to assess whether the use of minimally invasive surgery (MIS) affects the occurrence of PNI. Using the American College of Surgeons National Surgical Quality Improvement Program database, we examined rates of PNI among patients undergoing appendectomy, hysterectomy, colectomy, or radical prostatectomy between 2005 and 2012. We assessed the effect of MIS, as compared with open surgery, on PNI occurrence using logistic regression. Among 297,532 patients, of whom 175,884 (59.1%) underwent MIS, the rate of PNI was 0.03 per cent. Forty-four patients treated using MIS had PNI (0.03%) as compared with 63 who underwent open surgery (0.05%; P = 0.0002). There was a significant decrease in the proportion of surgeries resulting in PNI (P < 0.0001) over time. In univariate analysis, MIS was associated with a decreased occurrence of PNI (odds ratio 0.48, 95% confidence interval 0.33–0.71), but this became nonsignificant on multivariable analysis (odds ratio 0.71, 95% confidence interval 0.47–1.09). Increased operative time and smoking status were the only factors independently associated with an increased risk of PNI on multivariable analysis. MIS techniques during common abdominal-pelvic surgeries do not appear to increase the risk of PNI. Prolonged operative time and smoking are independently associated with an increased risk of PNI. Quality improvement initiatives to increase awareness of PNI and identify patients at increased risk of this preventable complication should be considered.

Same-day and delayed hospital discharge are associated with worse outcomes following total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 70-76 ◽  
Author(s):  
L. L. Nowak ◽  
E. H. Schemitsch
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Matched Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Multivariable Regression ◽  
Total Knee

Aims To evaluate the influence of discharge timing on 30-day complications following total knee arthroplasty (TKA). Patients and Methods We identified patients aged 18 years or older who underwent TKA between 2005 and 2016 from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database. We propensity score-matched length-of-stay (LOS) groups using all relevant covariables. We used multivariable regression to determine if the rate of complications and re-admissions differed depending on LOS. Results Our matched cohort consisted of 76 246 TKA patients (mean age 67 years (sd 9)). Patients whose LOS was zero and four days had an increased risk of major complications by an odds ratio (OR) of 1.8 (95% confidence interval (CI) 1.0 to 3.2) and 1.5 (95% CI 1.2 to 1.7), respectively, compared with patients whose LOS was two days. Patients whose LOS was zero, three, and four days had an increased risk of minor complications (OR 1.8 (95% CI 1.3 to 2.7), 1.2 (95% CI 1.0 to 1.4), and 1.6 (95% CI 1.4 to 1.9), respectively), compared with patients whose LOS was two days. In addition, a LOS of three days increased the risk of re-admission by an OR of 1.2 (95% CI 1.0 to 1.3), and a LOS of four days increased the risk of re-admission by an OR of 1.5 (95% CI 1.3 to 1.6), compared with a LOS of two days. Conclusion Patients discharged on days one to two postoperatively following TKA appear to have reduced major and minor complications compared with discharge on the day of surgery, or on days three to four. Prospective clinical data are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(7 Supple C):70–76

Risk Factors for Conversion from Laparoscopic to Open Surgery: Analysis of 2138 Converted Operations in the American College of Surgeons National Surgical Quality Improvement Program

2013 ◽  
Vol 79 (9) ◽  
pp. 914-921 ◽  
Author(s):  
Dominic Papandria ◽  
Thomas Lardaro ◽  
Daniel Rhee ◽  
Gezzer Ortega ◽  
Amany Gorgy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Open Surgery ◽  
Quality Improvement Program ◽  
Laparoscopic Procedure ◽  
Improvement Program ◽  
Cross Sectional ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
American College Of Surgeons

Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n = 1526 [1.9%]) and LCO bariatric procedures were less likely (n = 121 [0.3%]); appendectomy was intermediate (n = 491 [1.0%], P < 0.001). Patient factors associated with LCO included male sex ( P < 0.001), age 30 years or older ( P < 0.025), American Society of Anesthesiologists Class 2 to 4 ( P < 0.001), obesity ( P < 0.01), history of bleeding disorder ( P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis ( P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room ( P < 0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients.

scholarly journals Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

2013 ◽  
Vol 79 (10) ◽  
pp. 1034-1039 ◽  
Author(s):  
Mehraneh D. Jafari ◽  
Wissam J. Halabi ◽  
Fariba Jafari ◽  
Vinh Q. Nguyen ◽  
Michael J. Stamos ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Quality Improvement ◽  
Quality Improvement Program ◽  
Diverting Ileostomy ◽  
Improvement Program ◽  
Surgical Quality ◽  
Septic Complications ◽  
Increased Risk ◽  
Significant Difference ◽  
American College Of Surgeons

There is controversy regarding the potential benefits of diverting ileostomy after low anterior resection (LAR). This study aims to examine the morbidity associated with diverting ileostomy in rectal cancer. A retrospective review of LAR cases was performed using the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). Patients who underwent LAR with and without diversion were selected. Demographics, intraoperative events, and postoperative complications were reviewed. Among the 6337 cases sampled, 991 (16%) received a diverting ileostomy. Patients who were diverted were younger (60 vs 63 years), predominantly male (64 vs 53%), and more likely to have received pre-operative radiation (39 vs 12%). There was no significant difference in steroid use, weight loss, or intraoperative transfusion. Postoperatively, there was no significant difference in length of stay, rate of septic complications, wound infections, and mortality. The rate of reoperation was lower in the diverted group (4.5 vs 6.9%). Diversion was associated with a higher risk-adjusted rate of acute renal failure (OR 2.4; 95% CI (1.2, 4.6); P < 0.05). The use of diverting ileostomy reduces the rate of reoperation but is associated with an increased risk of acute renal insufficiency. These findings emphasize the need for refinement of patient selection and close follow-up to limit morbidity.

scholarly journals Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery

2021 ◽  
pp. 219256822110475
Author(s):  
Austen D. Katz ◽  
Jesse Galina ◽  
Junho Song ◽  
Sayyida Hasan ◽  
Dean Perfetti ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Large Scale ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Database Study ◽  
Increased Risk ◽  
Spinal Deformity Surgery

Study Design Retrospective database study. Objective Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts. This is the first large-scale database study to compare 30-day readmission, reoperation, morbidity, and value-per-operative time for navigated and conventional ASD surgery. Methods Adults were identified in the National Surgical Quality Improvement Program (NSQIP) database. Multivariate regression was used to compare outcomes between navigated and conventional surgery and to control for predictors and baseline differences. Results 3190 ASD patients were included. Navigated and conventional patients were similar. Navigated cases had greater operative time (405 vs 320 min) and mean RVUs per case (81.3 vs 69.7), and had more supplementary pelvic fixations (26.1 vs 13.4%) and osteotomies (50.3 vs 27.7%) ( P <.001). In univariate analysis, navigation had greater reoperation (9.9 vs 5.2%, P = .011), morbidity (57.8 vs 46.8%, P = .007), and transfusion (52.2 vs 41.8%, P = .010) rates. Readmission was similar (11.9 vs 8.4%). In multivariate analysis, navigation predicted reoperation (OR = 1.792, P = .048), but no longer predicted morbidity or transfusion. Most reoperations were infectious and hardware-related. Conclusions Despite controlling for patient-related and procedural factors, navigation independently predicted a 79% increased odds of reoperation but did not predict morbidity or transfusion. Readmission was similar between groups. This is explained, in part, by greater operative time and transfusion, which are risk factors for infection. Reoperation most frequently occurred for wound- and hardware-related reasons, suggesting navigation carries an increased risk of infectious-related events beyond increased operative time.

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