Jason T Wiseman1, Sherif Abdel-Misih2, Eliza W Beal3, Mohammad Y Zaidi4, Charles A Staley4, Travis Grotz5, Jennifer Leiting5, Keith Fournier6, Andrew J Lee6, Sean Dineen7, Benjamin Powers7, Jula Veerapong8, Joel M Baumgartner8, Callisia Clarke9, Sameer H Patel10, Vikrom Dhar10, Ryan J Hendrix11, Laura Lambert12, Daniel E Abbott13, Courtney Pokrzywa13, Mustafa Raoof14, Oliver Eng15, Nadege Fackche16, Jonathan Greer16, Timothy M Pawlik3, Jordan M Cloyd17. 1. Department of Surgery, The Ohio State University, Columbus, OH, USA. Electronic address: Jason.wiseman@osumc.edu. 2. Department of Surgery, Stony Brook University, Stony Brook, NY, USA. 3. Department of Surgery, The Ohio State University, Columbus, OH, USA. 4. Department of Surgery, Emory University, Atlanta, GA, USA. 5. Department of Surgery, Mayo Clinic, Rochester, MN, USA. 6. Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA. 8. Department of Surgery, University of California, San Diego, San Diego, CA, USA. 9. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. 10. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA. 11. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 12. Department of Surgery, Huntsman Cancer Institute, Salt Lake City, UT, USA. 13. Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA. 14. Department of Surgery, City of Hope Cancer Center, Duarte, CA, USA. 15. Department of Surgery, University of Chicago, Chicago, IL, USA. 16. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. 17. Department of Surgery, The Ohio State University, Columbus, OH, USA. Electronic address: jordan.cloyd@osumc.edu.
Abstract
BACKGROUND: While recent studies have introduced the composite measure of a textbook outcome (TO) for measuring postoperative outcomes, the incidence of a TO has not been characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM). STUDY DESIGN: All patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999 and 2017 from 12 institutions were included. A TO was defined as the absence of any of the following criteria: completeness of cytoreduction >1, reoperation within 90-days, readmission within 90-days, mortality within 90-days, any grade ≥2 complication, hospital stay >75th percentile, and non-home discharge. RESULTS: Among 1904 patients who underwent CRS, only 30.9% achieved a TO while 69.1% failed to achieve a TO most commonly because of postoperative complications. On multivariable analysis, factors associated with achieving a TO were age <65 years (OR: 1.5), albumin ≥3.5 g/dl (OR: 5.7), receipt of HIPEC (OR: 4.5), PCI ≤14 (OR: 2.2), intravenous fluid volume ≤10,000 ml (OR: 2.1), blood loss ≤1000 ml (OR: 4.2) and operative time <7 h (OR: 1.9); while receipt of neoadjuvant therapy (OR: 0.7) and liver resection (OR: 0.4) were associated with not achieving a TO (all p < 0.05). TO was associated with improved overall survival (median 159 months vs 56 months, p < 0.01) even after controlling for confounders on Cox regression (hazard ratio: 2.5, p < 0.01). CONCLUSION: Among patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and independently associated with worse overall survival.
BACKGROUND: While recent studies have introduced the composite measure of a textbook outcome (TO) for measuring postoperative outcomes, the incidence of a TO has not been characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM). STUDY DESIGN: All patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999 and 2017 from 12 institutions were included. A TO was defined as the absence of any of the following criteria: completeness of cytoreduction >1, reoperation within 90-days, readmission within 90-days, mortality within 90-days, any grade ≥2 complication, hospital stay >75th percentile, and non-home discharge. RESULTS: Among 1904 patients who underwent CRS, only 30.9% achieved a TO while 69.1% failed to achieve a TO most commonly because of postoperative complications. On multivariable analysis, factors associated with achieving a TO were age <65 years (OR: 1.5), albumin ≥3.5 g/dl (OR: 5.7), receipt of HIPEC (OR: 4.5), PCI ≤14 (OR: 2.2), intravenous fluid volume ≤10,000 ml (OR: 2.1), blood loss ≤1000 ml (OR: 4.2) and operative time <7 h (OR: 1.9); while receipt of neoadjuvant therapy (OR: 0.7) and liver resection (OR: 0.4) were associated with not achieving a TO (all p < 0.05). TO was associated with improved overall survival (median 159 months vs 56 months, p < 0.01) even after controlling for confounders on Cox regression (hazard ratio: 2.5, p < 0.01). CONCLUSION: Among patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and independently associated with worse overall survival.
Authors: Eliza W Beal; Djhenne Dalmacy; Alessandro Paro; J Madison Hyer; Jordan Cloyd; Mary Dillhoff; Aslam Ejaz; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2022-06-15 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