Esophagectomies for Malignancy Among General and Thoracic Surgeons: A Propensity Score Matched National Surgical Quality Improvement Program Analysis Stratified by Surgical Approach

2021 ◽  
pp. 000313482110385
Author(s):  
Shravan Leonard-Murali ◽  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Amy Tang ◽  
Zane Hammoud
Keyword(s):  
Quality Improvement ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Approach ◽  
Positive Margin ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Specialty ◽  
Surgical Quality ◽  
Positive Margin Rate

Previous studies of esophagectomy outcomes by surgical specialty do not address malignancy or surgical approach. We sought to evaluate these cases using a national database. The National Surgical Quality Improvement Program (NSQIP)–targeted esophagectomy data set was queried for esophagectomies for malignancy and grouped by surgeon specialty: thoracic surgery (TS) or general surgery (GS). 1:1 propensity score matching was performed. Associations of surgical specialty with outcomes of interest (30-day mortality, anastomotic leak, Clavien-Dindo grade ≥ 3, and positive margin rate) were assessed overall and in surgical approach subsets. 1463 patients met inclusion criteria (512 GS and 951 TS). Propensity score matching yielded matched groups of 512, with similar demographics, preoperative stage, and neoadjuvant therapy rates. All outcomes of interest were similar between TS and GS groups, both overall and when stratified by surgical approach. Esophagectomy for malignancy has a similar perioperative safety profile and positive margin rate among general and thoracic surgeons, regardless of surgical approach.

Does hepatectomy approach influence transfusion? An analysis of the National Surgical Quality Improvement Program database.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 447-447
Author(s):  
Jack P Silva ◽  
Nicholas G Berger ◽  
Susan Tsai ◽  
Kathleen K. Christians ◽  
Callisia Clarke ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
Quality Improvement Program ◽  
Red Blood Cell Transfusion ◽  
Perioperative Outcomes ◽  
Start Time ◽  
Improvement Program ◽  
Surgical Quality ◽  
Open Hepatectomy

447 Background: Transfusion is one of the causes of morbidity in hepatectomy, and is a predictor of mortality and cancer recurrence. This study sought to analyze the role of surgical approach in the incidence of transfusion in a large national dataset. Methods: The National Surgical Quality Improvement Program database identified patients undergoing hepatectomy between January 1, 2014 and December 31, 2014. Demographic information, surgical approach, perioperative characteristics, and short-term postoperative outcomes were compared for patients with and without perioperative red blood cell transfusion. Transfusions occurring from surgical start time to 72 hours postoperatively were included in the dataset. Results: A total of 3,064 patients were included in this study. Patients with right lobectomy and trisegmentectomy were more likely to receive transfusion compared to left and partial lobectomies (p < 0.001). Rate of transfusion was highest in unplanned minimally invasive conversion to open hepatectomy compared to open hepatectomy and minimally invasive surgery (25.2% vs. 21.2% vs. 6.7% respectively, p < 0.001). Patients requiring transfusion were more likely to suffer from other morbidity (47.1% vs. 19.6%, p < 0.001), had a longer median length of stay (7 vs. 5 days, p < 0.001), higher readmission rates (14.2% vs. 9.4%, p = 0.001), and higher 30-day mortality (4.9% vs. 0.8%, p < 0.001) compared to patients not receiving blood transfusions. Conclusions: Transfusion is the most common morbidity-defining complication associated with hepatectomy. Perioperative outcomes are significantly improved if no transfusion was needed. Further work should focus on avoiding unplanned conversion and minimizing blood loss.

Esophagectomies for malignancy among general and thoracic surgeons: A propensity score-matched NSQIP analysis stratified by surgical approach.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 166-166
Author(s):  
Shravan Leonard-Murali ◽  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Amy Tang ◽  
Zane T. Hammoud
Keyword(s):  
Propensity Score ◽  
Anastomotic Leak ◽  
Surgical Approach ◽  
Positive Margin ◽  
Perioperative Outcomes ◽  
National Database ◽  
Matched Cohort ◽  
Improvement Program ◽  
Positive Margin Rate ◽  
Grade 3

166 Background: Training of general and thoracic surgeons continues to diverge, especially with the increasing role for minimally invasive surgical (MIS) approaches. Previous studies of esophagectomy outcomes by specialty do not adequately address malignancy or surgical approach. We sought to evaluate perioperative outcomes of esophagectomy for malignancy stratified by surgical specialty and approach using a national database. Methods: The National Surgical Quality Improvement Program (NSQIP) Targeted Esophagectomy Dataset was queried for esophagectomies for malignancy and grouped by surgeon specialty: thoracic surgery (TS) or general surgery (GS). Those with missing data were excluded (n = 6). To account for confounding due to specialty selection bias, we performed propensity score matching (PSM) by age, body mass index, ethnicity, American Society of Anesthesiologists class ³ 3, and surgical approach in a 1:1 ratio. An absolute standardized difference of ≤ 0.1 was considered an appropriate balance. The primary outcome was mortality and secondary outcomes were anastomotic leak, Clavien-Dindo grade ≥ 3 and positive margin rate. Univariate logistic regression analysis was performed for these outcomes on the matched cohort, with stratification by surgical approach (open vs. MIS). Results: A total of 1463 patients met inclusion criteria (512 GS, 951 TS). After PSM each group was comprised of 512 patients with similar demographics, neoadjuvant chemotherapy and radiation rates, and preoperative stage. The TS group consisted of 169 (33.0%) open and 343 (67.0%) MIS cases, while the GS group consisted of 177 (34.6%) open and 335 (65.4%) MIS cases. Postoperative complications, including surgical site infection, pneumonia, pulmonary embolism, stroke, and myocardial infarction were similar between matched groups, and remained similar when stratified by surgical approach. Mortality rates were similar between the TS and GS groups, both overall (14 (2.7%) vs. 10 (2.0%)) and when stratified by surgical approach (MIS: 11 (3.2%) vs. 10 (3.0%), open: 3 (1.8%) vs. 0 (0%)). By univariate analysis of the matched cohort stratified by surgical approach, TS patients had similar odds as GS patients of anastomotic leak (open: adjusted odds ratio (AOR) = 1.11, 95% confidence interval (95%CI) = 0.58 – 2.15, p = 0.75; MIS: AOR = 0.70, 95%CI = 0.47 – 1.04, p = 0.08), Clavien-Dindo grade ≥ 3 (open: AOR = 1.27, 95%CI = 0.79 – 2.06, p = 0.32; MIS: AOR = 1.01, 95%CI = 0.73 – 1.39, p = 0.97), positive surgical margins (open: AOR = 0.75, 95%CI = 0.33 – 1.68, p = 0.49; MIS: AOR = 0.62, 95%CI = 0.35 – 1.07, p = 0.09), and mortality (open: unable to be calculated due to 0 deaths in the GS group; MIS: AOR = 1.08, 95%CI = 0.45 – 2.62, p = 0.87). Conclusions: Esophagectomy for malignancy had a similar perioperative safety profile and positive margin rate among general and thoracic surgeons, regardless of surgical approach.

Surgical specialty and outcomes for carotid endarterectomy: evidence from the National Surgical Quality Improvement Program

2014 ◽  
Vol 188 (1) ◽  
pp. 339-348 ◽  
Author(s):  
Laura M. Enomoto ◽  
Darren C. Hill ◽  
Peter W. Dillon ◽  
David C. Han ◽  
Christopher S. Hollenbeak
Keyword(s):  
Quality Improvement ◽  
Carotid Endarterectomy ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Specialty ◽  
Surgical Quality

Appendectomy at the time of ovarian cancer staging increases infectious complications: a National Surgical Quality Improvement Program (NSQIP) propensity score-stratified analysis

2020 ◽  
Vol 30 (10) ◽  
pp. 1542-1547
Author(s):  
Laurence Bernard ◽  
Innie Chen ◽  
Tien Le
Keyword(s):  
Ovarian Cancer ◽  
Quality Improvement ◽  
Propensity Score ◽  
Early Stage ◽  
Quality Improvement Program ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Time Of Surgery ◽  
Propensity Score Stratification

ObjectiveDespite evidence that routine elective appendectomy at the time of staging surgery for ovarian cancer is not warranted, it remains common practice in gynecology oncology. The objective of this study was to compare the surgical complication rates of women undergoing surgery for suspected early-stage ovarian malignancy with concurrent appendectomy to those who did not undergo appendectomy.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2010–2017 data were used to analyze the patient characteristics and outcomes of women undergoing staging surgeries for suspected early ovarian cancer. Women with pre-operative ascites, disseminated cancer, concurrent bowel surgery, or cytoreductive surgery were excluded. Multivariate logistic regression and propensity score stratification were used to assess 30-day post-operative outcomes.ResultsThree hundred and fifty-one of 2100 women (16.7%) underwent concurrent appendectomy at time of surgery, and the post-operative infection rate was 7.8%. Women with concurrent appendectomy had twice the odds of post-operative infection (OR 2.03, 95% CI 1.26 to 3.27) after controlling for clinically important risk factors. The increased odds of infection remained significant after propensity score stratification (OR 2.04, 95% CI 1.27 to 3.3). No association was observed with length of hospital stay, readmission, return to the operating room, or post-operative death.ConclusionsAppendectomy at time of surgery for suspected early-stage ovarian cancer is associated with significantly elevated odds of post-operative infection. Unless there is clinical suspicion for involvement, routine appendectomy should be abandoned in clinical practice.

scholarly journals Influence of age on surgical approach for hepatectomy: an analysis of the National Surgical Quality Improvement Program Database

HPB ◽  
2017 ◽  
Vol 19 ◽  
pp. S82-S83
Author(s):  
J. Silva ◽  
N. Berger ◽  
S. Tsai ◽  
K. Christians ◽  
C. Clarke ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Surgical Approach ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality
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