Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy

McMillan, Matthew T.; Allegrini, Valentina; Asbun, Horacio J.; Ball, Chad G.; Bassi, Claudio; Beane, Joal D.; Behrman, Stephen W.; Berger, Adam C.; Bloomston, Mark; Callery, Mark P.; Christein, John D.; Dickson, Euan J.; Dixon, Elijah; Drebin, Jeffrey A.; Castillo, Carlos Fernández del; Fisher, William E.; Fong, Zhi Ven; Haverick, Ericka; Hollis, Robert H.; House, Michael G.; Hughes, Steven J.; Jamieson, Nigel B.; Kent, Tara S.; Kowalsky, Stacy J.; Kunstman, John W.; Malleo, Giuseppe; McElhany, Amy L.; Salem, Ronald R.; Soares, Kevin C.; Sprys, Michael H.; Valero, Vicente; Watkins, Ammara A.; Wolfgang, Christopher L.; Zureikat, Amer H.; Vollmer, Charles M.

doi:10.1097/sla.0000000000001796

Cited by 96 publications

(57 citation statements)

References 36 publications

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“…We analyzed a large cohort of patients from two consociated, high-volume centers sharing a standardized technique for PJ with an overall CR-POPF rate of 16.8%, which is consistent with rates reported by other high-volume Institutions. [25][26][27] The main finding of the present study confirms what we have previously reported, 23 that PE sutures are independently associated with a lower incidence of CR-POPF. This potential protective effect against CR-POPF is virtually maintained across all CR-POPF risk zones, but the negligible risk group, in which the POPF incidence is nil.…”

Section: Discussionsupporting

confidence: 92%

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Andrianello

Marchegiani

Malleo

et al. 2018

HPB

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Section: Discussionsupporting

confidence: 92%

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Andrianello

Marchegiani

Malleo

et al. 2018

HPB

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“…Several large-volume databases have also been utilized to develop preoperative and postoperative risk stratification protocols for a given procedure. The results from large database studies provide better evidence-based guidelines for decisions made regarding patient care preoperatively, intraoperatively, and postoperatively (10)(11)(12).…”

Section: Large-volume Databasesmentioning

confidence: 99%

Surgical research using national databases

2016

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Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations.The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

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“…This risk calculator was not procedure‐specific, but it performed well when tested in procedure‐specific populations . However, a recent study that included patients undergoing pancreatoduodenectomy showed that incorporating procedure‐specific complications improved the prediction of morbidity and mortality compared to the NSQIP universal surgical risk calculator . We did not develop procedure‐specific scores because of small sample size for some procedures.…”

Section: Discussionmentioning

confidence: 99%

“…36 However, a recent study that included patients undergoing pancreatoduodenectomy showed that incorporating procedure-specific complications improved the prediction of morbidity and mortality compared to the NSQIP universal surgical risk calculator. 36,37 We did not develop procedure-specific scores because of small sample size for some procedures. Moreover, it may not be practical to develop, maintain, update, and use separate comorbidity scores for each procedure and outcome.…”

Section: Discussionmentioning

confidence: 99%

Development of comorbidity score for patients undergoing major surgery

Mehta

Shan

Sura

et al. 2019

Health Services Research

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Objective To develop and validate a claims‐based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores. Data Source Five percent Medicare data from 2007 to 2014. Study Design Retrospective cohort study of patients aged ≥65 years undergoing six major operations (N = 99 250). Data Collection One‐year mortality was the primary outcome. Secondary outcomes were hospital mortality, 30‐day mortality, 30‐day readmission, and length of stay. The comorbidity score was developed in the derivation cohort (70 percent sample) using logistic regression model. The comorbidity score was calibrated and validated in the validation cohort (30 percent sample), and compared against the Charlson, Elixhauser, and Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS‐HCC) comorbidity scores using c‐statistic, net reclassification improvement, and integrated discrimination improvement. Principal Findings In the validation cohort, the surgery‐specific comorbidity score was well calibrated and performed better than the Charlson, Elixhauser, and CMS‐HCC comorbidity scores for all outcomes; the performance was comparable to the CMS‐HCC for 30‐day readmission. For example, the surgery‐specific comorbidity score (c‐statistic = 0.792; 95% CI, 0.785‐0.799) had greater discrimination than the Charlson (c‐statistic = 0.747; 95% CI, 0.739‐0.755), Elixhauser (c‐statistic = 0.747; 95% CI, 0.735‐0.755), or CMS‐HCC (c‐statistic = 0.755; 95% CI, 0.747‐0.763) scores in predicting 1‐year mortality. The net reclassification improvement and integrated discrimination improvement were greater for surgery‐specific comorbidity score compared to the Charlson, Elixhauser, and CMS‐HCC scores. Conclusions Compared to commonly used comorbidity measures, a surgery‐specific comorbidity score better predicted outcomes in the surgical population.

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Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy

Abstract: Procedure-specific complication risk influences outcomes after pancreatoduodenectomy; therefore, risk adjustment for performance assessment and comparative research should consider these preoperative and intraoperative factors along with conventional ACS-NSQIP preoperative variables.

Cited by 96 publications

References 36 publications

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Polyester sutures for pancreaticojejunostomy protect against postoperative pancreatic fistula: a case–control, risk-adjusted analysis

Surgical research using national databases

Development of comorbidity score for patients undergoing major surgery

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