scholarly journals Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program Pediatric database analysis

2016 ◽  
Vol 18 (4) ◽  
pp. 416-422 ◽  
Author(s):  
Jacob Cherian ◽  
Kristen A. Staggers ◽  
I-Wen Pan ◽  
Melissa Lopresti ◽  
Andrew Jea ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Operating Room ◽  
Defect Size ◽  
Quality Improvement Program ◽  
Perioperative Outcomes ◽  
Wound Complications ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Surgical Quality ◽  
Myelomeningocele Repair

OBJECTIVE Due to improved nutrition and early detection, myelomeningocele repair is a relatively uncommon procedure. Although previous studies have reviewed surgical trends and predictors of outcomes, they have relied largely on single-hospital experiences or on databases centered on hospital admission data. Here, the authors report 30-day outcomes of pediatric patients undergoing postnatal myelomeningocele repair from a national prospective surgical outcomes database. They sought to investigate the association between preoperative and intraoperative factors on the occurrence of 30-day complications, readmissions, and unplanned return to operating room events. METHODS The 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (NSQIP-P) was queried for all patients undergoing postnatal myelomeningocele repair. Patients were subdivided on the basis of the size of the repair (< 5 cm vs > 5 cm). Preoperative variables, intraoperative characteristics, and postoperative 30-day events were tabulated from prospectively collected data. Three separate outcomes for complication, unplanned readmission, and return to the operating room were analyzed using univariate and multivariate logistic regression. Rates of associated CSF diversion operations and their timing were also analyzed. RESULTS A total of 114 patients were included; 54 had myelomeningocele repair for a defect size smaller than 5 cm, and 60 had repair for a defect size larger than 5 cm. CSF shunts were placed concurrently in 8% of the cases. There were 42 NSQIP-defined complications in 31 patients (27%); these included wound complications and infections, in addition to others. Postoperative wound complications were the most common and occurred in 27 patients (24%). Forty patients (35%) had at least one subsequent surgery within 30 days. Twenty-four patients (21%) returned to the operating room for initial shunt placement. Unplanned readmission occurred in 11% of cases. Both complication and return to operating room outcomes were statistically associated with age at repair. CONCLUSIONS The NSQIP-P allows examination of 30-day perioperative outcomes from a national prospectively collected database. In this cohort, over one-quarter of patients undergoing postnatal myelomeningocele repair experienced a complication within 30 days. The complication rate was significantly higher in patients who had surgical repair within the first 24 hours of birth than in patients who had surgery after the 1st day of life. The authors also highlight limitations of investigating myelomeningocele repair using NSQIP-P and advocate the importance of disease-specific data collection.

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.

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.

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