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.

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.

Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders

2019 ◽  
Vol 33 (08) ◽  
pp. 745-749 ◽  
Author(s):  
Chukwuweike U. Gwam ◽  
Assem Sultan ◽  
Samuel Rosas ◽  
Rashad Sullivan ◽  
Michael Seem ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Demographic Variables ◽  
Perioperative Outcomes ◽  
Patient Specific ◽  
Matched Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Lengths Of Stay ◽  
Increased Risk ◽  
Discharge Status

AbstractWith a growing prevalence for chronic renal failure, arthroplasty surgeons will find it more likely to have dialysis dependent patients present for knee replacement. Previous retrospective studies using a matched cohort of patients have reported worse perioperative outcomes for dialysis-dependent patients. However, many of these studies failed to control for pertinent confounders. This study aims to fill in that void. The present study compares lengths of stay, discharge status, and 30-day outcomes between dialysis-dependent TKA recipients and a matched cohort of nondialysis dependent TKA recipients. The National Surgical Quality Improvement Program database was used to identify the study cohorts. Patients were propensity score matched based on patient-specific demographic variables, preoperative functional status, and preoperative laboratory values. Generalized regression models were conducted to assess the effects of dialysis dependency on perioperative outcomes. Dialysis dependent patients demonstrated longer mean lengths of stay (+1.14) and a lower likelihood for home discharge (odds ratio [OR] = 0.503). There was no increased risk of 30-day complications in dialysis dependent TKA patients. Our findings demonstrate no increased risk of 30-day complications after TKA when adjusting for pertinent confounders. This suggests TKA is safe for well optimized dialysis dependent patients prior to surgery.

Abdominal versus Perineal Approach for Treatment of Rectal Prolapse: Comparable Safety in a Propensity-matched Cohort

2013 ◽  
Vol 79 (7) ◽  
pp. 686-692 ◽  
Author(s):  
W. Conan Mustain ◽  
Daniel L. Davenport ◽  
Jeremy P. Parcells ◽  
H. David Vargas ◽  
Jon S. Hourigan
Keyword(s):  
Propensity Score ◽  
Rectal Prolapse ◽  
Operative Approach ◽  
Matched Cohort ◽  
Perineal Approach ◽  
Improvement Program ◽  
Data Set ◽  
Clinical Risk ◽  
Significant Difference ◽  
The Impact

Abdominal operations for rectal prolapse are associated with lower recurrence rates than perineal procedures but presumed higher morbidity. Therefore, perineal procedures are recommended for patients deemed unfit for abdominal repair. Consequently, bias confounds retrospective comparisons of the two approaches. To clarify the impact of operative approach on outcomes, we analyzed abdominal and perineal procedures in a propensity score-matched analysis. We selected patients undergoing surgery for rectal prolapse from the American College of Surgeons National Surgical Quality Improvement Program data set from 2005 to 2010. We grouped procedures as abdominal or perineal. We identified preoperative variables predictive of complications and regressed against operative approach. The resulting propensity score was used to select a matched cohort with similar clinical risk. We identified 2188 patients (848 abdominal [38.8%]; 1340 perineal [61.2%]). Patients undergoing the perineal approach had higher rates of most risk variables. Propensity matching resulted in 563 matched pairs (1126 patients) with similar clinical risk. In this matched cohort, no significant difference was found in the rate of any complication between the operative approaches; mortality was 0.9 per cent in each group ( P = 1.0). Relative risk for major morbidity after abdominal approach was 1.39 (95% confidence interval, 0.92 to 2.10; P = 0.15). Although many patients with rectal prolapse are high risk for abdominal surgery, our study indicates that many patients treated by perineal repair could be safely treated with a more durable operation.

scholarly journals Does Obesity Explain the Effect of the Metabolic Syndrome on Complications Following Elective Lumbar Fusion? A Propensity Score Matched Analysis

2018 ◽  
Vol 8 (7) ◽  
pp. 683-689 ◽  
Author(s):  
Francis Lovecchio ◽  
Michael C. Fu ◽  
Sravisht Iyer ◽  
Michael Steinhaus ◽  
Todd Albert
Keyword(s):  
Metabolic Syndrome ◽  
Propensity Score ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Lumbar Fusion ◽  
Independent Effect ◽  
Perioperative Outcomes ◽  
Wound Complications ◽  
Improvement Program ◽  
The Metabolic Syndrome

Study Design: Propensity score matched retrospective cohort study. Objectives: Obesity is a major confounder in determining the independent effect of metabolic syndrome (MetS) on complications after spinal surgery. The purpose of this study is to differentiate MetS from obesity as an independent influence on perioperative outcomes after elective lumbar spine fusion. Methods: One- to 3-level posterior spinal fusion cases were identified from the 2011-2014 American College of Surgeons’ National Surgical Quality Improvement Program. To determine the effects of MetS outside of obesity itself, patients with MetS were first compared to a no-MetS cohort and then to an obese-only no-MetS cohort. Two propensity score matches based on demographics, comorbidities, surgical complexity, and diagnosis were used to match patients in 1:1 ratios and compare outcomes. Logistic regression with propensity score adjustment was further utilized as a secondary method of reducing selection bias. Results: Out of 18 605 patients that met criteria for inclusion, 1903 (10.2%) met our definition of MetS. Patients with MetS had a higher rate of wound complications (3.8% vs 2.7% obese no MetS, P = .045; vs 2.6% no MetS, P = .035), readmissions (7.4% vs 2.2% obese no MetS, P < .001; vs 4.6% no MetS, P < .001), and extended length of stay (29.1% vs 23.9% obese no MetS, P < .001; vs 23.5% no MetS, P < .001). Patients with MetS were more likely to experience a wound complication (odds ratio = 1.47, 95% confidence interval = 1.02-2.12) or readmission (odds ratio = 1.48, 95% confidence interval = 1.22-1.80). Conclusions: Even after controlling for obesity, MetS is an independent risk factor for adverse short-term outcomes. These findings have various implications for preoperative risk stratification and reduction strategies.

scholarly journals Medical Comanagement of Hip Fracture Patients Is Not Associated with Superior Perioperative Outcomes: A Propensity Score-Matched Retrospective Cohort Analysis of the National Surgical Quality mprovement Project

2019 ◽  
Vol 15 (8) ◽  
pp. 468-474 ◽  
Author(s):  
Bryan G Maxwell ◽  
Amer Mirza
Keyword(s):  
Hip Fracture ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Composite Endpoint ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Retrospective Cohort Analysis

BACKGROUND: Medical comanagement entails a significant commitment of clinical resources with the aim of improving perioperative outcomes for patients admitted with hip fractures. To our knowledge, no national analyses have demonstrated whether patients benefit from this practice. METHODS: We performed a retrospective cohort analysis of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted user file for hip fracture 2016-2017. Medical comanagement is a dedicated variable in the NSQIP. Propensity score matching was performed to control for baseline differences associated with comanagement. Matched pairs binary logistic regression was then performed to determine the effect of comanagement on the following primary outcomes: mortality and a composite endpoint of major morbidity. RESULTS: Unadjusted analyses demonstrated that patients receiving medical comanagement were older and sicker with a greater burden of comorbidities. Comanagement did not have a higher proportion of patients participating in a standardized hip fracture program (53.6% vs 53.7%; P > .05). Comanagement was associated with a higher unadjusted rate of mortality (6.9% vs 4.0%, odds ratio [OR] 1.79: 1.44-2.22; P < .0001) and morbidity (19.5% vs 9.6%, OR 2.28: 1.98-2.63; P < .0001). After propensity score matching was used to control for baseline differences associated with comanagement, patients in the comanagement cohort continued to demonstrate inferior mortality (OR 1.36: 1.02-1.81; P = .033) and morbidity (OR 1.82: 1.52-2.20; P < .0001). CONCLUSIONS: This analysis does not provide evidence that dedicated medical comanagement of hip fracture patients is associated with superior perioperative outcomes. Further efforts may be needed to refine opportunities to modify the significant morbidity and mortality that persists in this population.

scholarly journals PD20-09 SURGICAL APPROACH DOES NOT IMPACT POSITIVE MARGIN RATE IN PARTIAL NEPHRECTOMY FOR LARGE RENAL MASSES

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Abimbola Ayangbesan ◽  
David Golombos ◽  
Padraic O'Malley ◽  
Patrick Lewicki ◽  
LaMont Barlow ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Approach ◽  
Positive Margin ◽  
Renal Masses ◽  
Positive Margin Rate

Perioperative outcomes of open and minimally invasive nephroureterectomy and pre-operative predictors of complications: An analysis using the National Surgical Quality Improvement Program database.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 408-408
Author(s):  
Nachiketh Soodana-Prakash ◽  
Nicola Pavan ◽  
Raymond R Balise ◽  
Bruno Nahar ◽  
Samarpit Rai ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Minimally Invasive ◽  
Perioperative Complications ◽  
Quality Improvement Program ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Surgical Methods ◽  
Significant Difference ◽  
Grade 3

408 Background: Minimally invasive nephroureterectomy (MINU) is an alternative approach to open nephroureterectomy for management of upper tract urothelial carcinoma (UTUC). Oncological outcomes between the two methods has been shown to be similar. We analyzed the NSQIP database to determine if there was a significant difference in perioperative complications between MINU and open nephroureterectomy. Methods: Between 2005 and 2013, a total of 1,027 patients were identified in the National Surgical Quality Improvement Program Database (NSQIP) that underwent nephrouretectomy for UTUC. Pre−operative covariates were analyzed to predict the rates of severe (Clavien−Dindo grade ≥ 3) perioperative complications. Univariate and multivariate logistic regression models (controlling for demographic and comorbid conditions) were built to predict severe complications and exploratory analyses were done to predict 18 common complications. Results: A total of 669 (65%) and 359 (35%) patients underwent MINU and open nephroureterectomy, respectively. Open nephroureterectomy was associated with a higher rate of severe complications (OR 1.87, CI 1.02−3.4, p = 0.04). Post−operative occurrence of pneumonia (OR 4.5, CI 1.7−3.4, p < 0.001) and transfusions (OR 2.5, CI 1.7−3.6, p < 0.0001) were lower for MINU compared to open nephroureterectomy. There were no significant differences between the two surgical methods with respect to incidence of other complications. MINU took longer on average than open nephroureterectomy (median 219 mins vs. 200 mins, p < 0.001). Time to discharge was longer for open nephroureterectomy compared to MINU (median 6.25 days vs. 5 days, p < 0.0001). Conclusions: Post−operative pneumonia and occurrence of severe complications (Clavien−Dindo grade ≥ 3) were higher for the open nephroureterectomy group compared to MINU. These data suggest that MINU is an acceptable surgical approach for management of UTUC that is associated with lower morbidity compared to open nephroureterectomy.

Sign in / Sign up

Export Citation Format

Share Document