scholarly journals Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

2021 ◽  
Vol 12 ◽  
pp. 144
Author(s):  
Krissia M. Rivera Perla ◽  
Nathan J. Pertsch ◽  
Owen P. Leary ◽  
Catherine M. Garcia ◽  
Oliver Y. Tang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Older Patients ◽  
Tumor Resection ◽  
Major Complication ◽  
Improvement Program ◽  
Surgical Quality ◽  
Improvement Project ◽  
Prolonged Length ◽  
Cranial Surgery ◽  
American Society

Background: Poorer outcomes for infratentorial tumor resection have been reported. There is a lack of large multicenter analyses describing infratentorial surgery outcomes in older patients. We characterized outcomes in patients aged ≥65 years undergoing infratentorial cranial surgery. Methods: The National Surgical Quality Improvement Project database was queried from 2012 to 2018 for patients ≥18 years undergoing elective infratentorial cranial surgery for tumor resection. Patients were grouped into 65–74 years, ≥75 years, and 18–64 years cohorts. Multivariable regressions compared outcome measures. Results: Of 2212 patients, 28.3% were ≥65 years, of whom 24.8% were ≥75 years. Both older subpopulations had worse American Society of Anesthesiologists classification compared to controls (P < 0.01) and more comorbidities. Patients 65–74 and ≥75 years had higher rates of major complication (adjusted odds ratio [aOR] = 1.77, 95% CI = 1.13–2.79 and aOR = 3.44, 95% CI = 1.96–6.02, respectively), prolonged length of stay (LOS) (aOR = 1.89, 95% CI = 1.15–3.12 and aOR = 3.00, 95% CI = 1.65–5.44, respectively), and were more likely to be discharged to a location other than home (aOR = 2.43, 95% CI =1.73–3.4 and aOR = 3.41, 95% CI = 2.18–5.33, respectively) relative to controls. Patients ≥75 had higher rates of readmission (aOR = 1.86, 95% CI = 1.13–3.08) and mortality (aOR = 3.28, 95% CI = 1.21–8.89) at 30 days. Conclusion: Patients ≥65 years experienced more complications, prolonged LOS, and were less often discharged home than adults <65 years. Patients ≥75 years had higher rates of 30-day readmission and mortality. There is a need for careful preoperative optimization in older patients undergoing infratentorial tumor cranial surgery.

Readmission After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis

Neurosurgery ◽  
2017 ◽  
Vol 80 (4) ◽  
pp. 551-562 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Sandra C. Yan ◽  
Timothy R. Smith ◽  
Pablo A. Valdes ◽  
William B. Gormley ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Functional Status ◽  
Tumor Resection ◽  
Quality Improvement Program ◽  
Unplanned Readmission ◽  
Index Hospitalization ◽  
Improvement Program ◽  
Surgical Quality ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract BACKGROUND: Although readmission has become a common quality indicator, few national studies have examined this metric in patients undergoing cranial surgery. OBJECTIVE: To utilize the prospective National Surgical Quality Improvement Program 2011-2013 registry to evaluate the predictors of unplanned 30-d readmission and postdischarge mortality after cranial tumor resection. METHODS: Multivariable logistic regression was applied to screen predictors, which included patient age, sex, tumor location and histology, American Society of Anesthesiologists class, functional status, comorbidities, and complications from the index hospitalization. RESULTS: Of the 9565 patients included, 10.7% (n = 1026) had an unplanned readmission. Independent predictors of unplanned readmission were male sex, infratentorial location, American Society of Anesthesiologists class 3 designation, dependent functional status, a bleeding disorder, and morbid obesity (all P ≤ .03). Readmission was not associated with operative time, length of hospitalization, discharge disposition, or complications from the index admission. The most common reasons for readmission were surgical site infections (17.0%), infectious complications (11.0%), venous thromboembolism (10.0%), and seizures (9.4%). The 30-d mortality rate was 3.2% (n = 367), of which the majority (69.7%, n = 223) occurred postdischarge. Independent predictors of postdischarge mortality were greater age, metastatic histology, dependent functional status, hypertension, discharge to institutional care, and postdischarge neurological or cardiopulmonary complications (all P &lt; .05). CONCLUSION: Readmissions were common after cranial tumor resection and often attributable to new postdischarge complications rather than exacerbations of complications from the initial hospitalization. Moreover, the majority of 30-d deaths occurred after discharge from the index hospitalization. The preponderance of postdischarge mortality and complications requiring readmission highlights the importance of posthospitalization management.

scholarly journals Radical cystectomy in patients with disseminated disease: An assessment of perioperative outcomes using the National Surgical Quality Improvement Program database

2017 ◽  
Vol 11 (8) ◽  
pp. 244-8 ◽  
Author(s):  
Christopher Wallis ◽  
Suneil Khana ◽  
Mohammad Hajiha ◽  
Robert K. Nam ◽  
Raj Satkunasivam
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Radical Cystectomy ◽  
Pulmonary Complications ◽  
Quality Improvement Program ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Length ◽  
Disseminated Disease

Introduction: We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer.Methods: We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications.Results: Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02–6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00‒26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07–0.79).Conclusions: Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational

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