Oliver S Eng1, Andrew M Blakely2, Kelly J Lafaro3, Keith F Fournier4, Nadege T Fackche3, Fabian M Johnston3, Sean Dineen5, Benjamin Powers5, Ryan Hendrix6, Laura A Lambert7, Sean Ronnekleiv-Kelly8, Kara Vande Walle8, Travis E Grotz9, Jennifer L Leiting9, Sameer H Patel10, Vikrom K Dhar10, Joel M Baumgartner11, Andrew M Lowy11, Callisia N Clarke12, Harveshp Mogal12, Mohammad Y Zaidi13, Charles A Staley13, Charles Kimbrough14, Jordan M Cloyd14, Byrne Lee15, Mustafa Raoof16. 1. Department of Surgery, University of Chicago, Chicago, Illinois. 2. Department of Surgery, National Cancer Institute, Bethesda, Maryland. 3. Department of Surgery, Johns Hopkins University, Baltimore, Maryland. 4. Department of Surgery, MD Anderson Cancer Center, Houston, Texas. 5. Department of Surgery, Moffitt Cancer Center, Tampa, Florida. 6. Department of Surgery, University of Massachusetts, Worcester, Massachusetts. 7. Department of Surgery, University of Utah, Salt Lake City, Utah. 8. Department of Surgery, University of Wisconsin, Madison, Wisconsin. 9. Department of Surgery, Mayo Clinic, Rochester, Minnesota. 10. Department of Surgery, University of Cincinnati, Cincinnati, Ohio. 11. Department of Surgery, University of California at San Diego, San Diego, California. 12. Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 13. Department of Surgery, Emory University, Atlanta, Georgia. 14. Department of Surgery, Ohio State University, Columbus, Ohio. 15. Department of Surgery, Stanford University, Palo Alto, California. 16. Department of Surgery, City of Hope National Medical Center, Duarte, California.
Abstract
BACKGROUND: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. METHODS: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. RESULTS: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P < .001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P < .001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. CONCLUSIONS: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.
BACKGROUND: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. METHODS: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. RESULTS: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P < .001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P < .001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. CONCLUSIONS: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.
Authors: Kevin M Turner; Mackenzie C Morris; Aaron M Delman; Dennis Hanseman; Fabian M Johnston; Jonathan Greer; Kara Vande Walle; Daniel E Abbott; Mustafa Raoof; Travis E Grotz; Keith Fournier; Sean Dineen; Jula Veerapong; Ugwuji Maduekwe; Anai Kothari; Charles A Staley; Shishir K Maithel; Laura A Lambert; Alex C Kim; Jordan M Cloyd; Gregory C Wilson; Jeffrey J Sussman; Syed A Ahmad; Sameer H Patel Journal: J Gastrointest Surg Date: 2022-10-18 Impact factor: 3.267
Authors: Huiyu Deng; Zahra Eftekhari; Cameron Carlin; Jula Veerapong; Keith F Fournier; Fabian M Johnston; Sean P Dineen; Benjamin D Powers; Ryan Hendrix; Laura A Lambert; Daniel E Abbott; Kara Vande Walle; Travis E Grotz; Sameer H Patel; Callisia N Clarke; Charles A Staley; Sherif Abdel-Misih; Jordan M Cloyd; Byrne Lee; Yuman Fong; Mustafa Raoof Journal: JAMA Netw Open Date: 2022-05-02