Sanjay Mohanty1, Jennifer Paruch2, Karl Y Bilimoria3, Mark Cohen4, Vivian E Strong5, Sharon M Weber6. 1. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Henry Ford Hospital, Detroit, MI. 2. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL. 3. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Surgical Outcomes and Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL. 4. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL. 5. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. 6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: webers@surgery.wisc.edu.
Abstract
BACKGROUND: Most risk adjustment approaches adjust for patient comorbidities and the primary procedure. However, procedures done at the same time as the index case may increase operative risk and merit inclusion in adjustment models for fair hospital comparisons. Our objectives were to evaluate the impact of surgical complexity on postoperative outcomes and hospital comparisons in gastric cancer surgery. METHODS: Patients who underwent gastric resection for cancer were identified from a large clinical dataset. Procedure complexity was characterized using secondary procedure CPT codes and work relative value units (RVUs). Regression models were developed to evaluate the association between complexity variables and outcomes. The impact of complexity adjustment on model performance and hospital comparisons was examined. RESULTS: Among 3,467 patients who underwent gastrectomy for adenocarcinoma, 2,171 operations were distal and 1,296 total. A secondary procedure was reported for 33% of distal gastrectomies and 59% of total gastrectomies. Six of 10 secondary procedures were associated with adverse outcomes. For example, patients who underwent a synchronous bowel resection had a higher risk of mortality (odds ratio [OR], 2.14; 95% CI, 1.07-4.29) and reoperation (OR, 2.09; 95% CI, 1.26-3.47). Model performance was slightly better for nearly all outcomes with complexity adjustment (mortality c-statistics: standard model, 0.853; secondary procedure model, 0.858; RVU model, 0.855). Hospital ranking did not change substantially after complexity adjustment. CONCLUSION: Surgical complexity variables are associated with adverse outcomes in gastrectomy, but complexity adjustment does not affect hospital rankings appreciably.
BACKGROUND: Most risk adjustment approaches adjust for patient comorbidities and the primary procedure. However, procedures done at the same time as the index case may increase operative risk and merit inclusion in adjustment models for fair hospital comparisons. Our objectives were to evaluate the impact of surgical complexity on postoperative outcomes and hospital comparisons in gastric cancer surgery. METHODS:Patients who underwent gastric resection for cancer were identified from a large clinical dataset. Procedure complexity was characterized using secondary procedure CPT codes and work relative value units (RVUs). Regression models were developed to evaluate the association between complexity variables and outcomes. The impact of complexity adjustment on model performance and hospital comparisons was examined. RESULTS: Among 3,467 patients who underwent gastrectomy for adenocarcinoma, 2,171 operations were distal and 1,296 total. A secondary procedure was reported for 33% of distal gastrectomies and 59% of total gastrectomies. Six of 10 secondary procedures were associated with adverse outcomes. For example, patients who underwent a synchronous bowel resection had a higher risk of mortality (odds ratio [OR], 2.14; 95% CI, 1.07-4.29) and reoperation (OR, 2.09; 95% CI, 1.26-3.47). Model performance was slightly better for nearly all outcomes with complexity adjustment (mortality c-statistics: standard model, 0.853; secondary procedure model, 0.858; RVU model, 0.855). Hospital ranking did not change substantially after complexity adjustment. CONCLUSION: Surgical complexity variables are associated with adverse outcomes in gastrectomy, but complexity adjustment does not affect hospital rankings appreciably.
Authors: Kevin R Kasten; Adam C Celio; Lauren Trakimas; Mark L Manwaring; Konstantinos Spaniolas Journal: Surg Endosc Date: 2017-07-19 Impact factor: 4.584