Donald J Lucas1, Timothy M Pawlik2. 1. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
Abstract
OBJECTIVE: To assess the impact of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participation on outcomes in gastrointestinal surgical oncology. STUDY DESIGN: A total of 6,076 resections for esophageal, gastric, pancreatic, hepatobiliary, and colorectal cancers at 316 hospitals from the 2006 to 2011 ACS NSQIP were examined. Thirty-day complication rates were analyzed longitudinally over time with the use of multiple regression; we adjusted for operation type and preoperative risk factors. RESULTS: The procedure mix was 3% esophagectomy, 5% gastrectomy, 16% pancreatectomy, 4% hepatectomy, 63% colectomy, and 9% proctectomy. Median age was 66 years, and 52% were male, 41% were American Society of Anesthesiologists class 2, and 52% were American Society of Anesthesiologists 3. Depending on anatomic surgical site, 21-45% of patients experienced a postoperative complication and 1.1-4.4% died. The incidence of patients with any complication decreased from 28 to 24% over the period (risk-adjusted odds ratio 0.95 per year, 95% confidence interval 0.94-0.96). In contrast, there was no substantial change in risk-adjusted mortality over the period (odds ratio 1.03, 95% confidence interval 0.99-1.07). CONCLUSION: There was a decrease in complications over time for ACS NSQIP participants in gastrointestinal surgical oncology, but mortality did not decrease.
OBJECTIVE: To assess the impact of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participation on outcomes in gastrointestinal surgical oncology. STUDY DESIGN: A total of 6,076 resections for esophageal, gastric, pancreatic, hepatobiliary, and colorectal cancers at 316 hospitals from the 2006 to 2011 ACS NSQIP were examined. Thirty-day complication rates were analyzed longitudinally over time with the use of multiple regression; we adjusted for operation type and preoperative risk factors. RESULTS: The procedure mix was 3% esophagectomy, 5% gastrectomy, 16% pancreatectomy, 4% hepatectomy, 63% colectomy, and 9% proctectomy. Median age was 66 years, and 52% were male, 41% were American Society of Anesthesiologists class 2, and 52% were American Society of Anesthesiologists 3. Depending on anatomic surgical site, 21-45% of patients experienced a postoperative complication and 1.1-4.4% died. The incidence of patients with any complication decreased from 28 to 24% over the period (risk-adjusted odds ratio 0.95 per year, 95% confidence interval 0.94-0.96). In contrast, there was no substantial change in risk-adjusted mortality over the period (odds ratio 1.03, 95% confidence interval 0.99-1.07). CONCLUSION: There was a decrease in complications over time for ACS NSQIP participants in gastrointestinal surgical oncology, but mortality did not decrease.
Authors: Sunil G Sheth; Darwin L Conwell; David C Whitcomb; Matthew Alsante; Michelle A Anderson; Jamie Barkin; Randall Brand; Gregory A Cote; Steven D Freedman; Andres Gelrud; Fred Gorelick; Linda S Lee; Katherine Morgan; Stephen Pandol; Vikesh K Singh; Dhiraj Yadav; C Mel Wilcox; Phil A Hart Journal: Pancreatology Date: 2017-02-28 Impact factor: 3.996
Authors: Katiuscha Merath; Qinyu Chen; Fabio Bagante; Sorin Alexandrescu; Hugo P Marques; Luca Aldrighetti; Shishir K Maithel; Carlo Pulitano; Matthew J Weiss; Todd W Bauer; Feng Shen; George A Poultsides; Olivier Soubrane; Guillaume Martel; B Groot Koerkamp; Alfredo Guglielmi; Endo Itaru; Jordan M Cloyd; Timothy M Pawlik Journal: JAMA Surg Date: 2019-06-19 Impact factor: 14.766
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