Influence of hospital teaching status on the chance to achieve a textbook outcome after hepatopancreatic surgery for cancer among Medicare beneficiaries

Mehta, Rittal; Paredes, Anghela Z.; Tsilimigras, Diamantis I.; Moro, Amika; Sahara, Kota; Farooq, Ayesha; Dillhoff, Mary; Cloyd, Jordan M.; Tsung, Allan; Ejaz, Aslam; Pawlik, Timothy M.

doi:10.1016/j.surg.2020.02.024

Cited by 60 publications

(44 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 48 – 50 Pancreatic resection is also a surgical procedure that is highly sensitive to the volume–outcome relationship, as well as the overall quality of the hospital in which the procedure is performed. 21 , 38 , 51 As such, disparities in 90-day mortality following pancreatectomy may be attributed to differences in access to high-quality hospitals. For example, Sarrazin et al reported that Medicare beneficiaries who were from highly segregated areas were more likely to be hospitalized for acute myocardial infarction in a high-mortality hospital.…”

Section: Discussionmentioning

confidence: 99%

Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Residential racial desegregation has demonstrated improved economic and education outcomes. The degree of racial community segregation relative to surgical outcomes has not been examined. Patients and Methods Patients undergoing pancreatic resection between 2013 and 2017 were identified from Medicare Standard Analytic Files. A diversity index for each county was calculated from the American Community Survey. Multivariable mixed-effects logistic regression with a random effect for hospital was used to measure the association of the diversity index level with textbook outcome (TO). Results Among the 24,298 Medicare beneficiaries who underwent a pancreatic resection, most patients were male ( n = 12,784, 52.6%), White ( n = 21,616, 89%), and had a median age of 72 (68–77) years. The overall incidence of TO following pancreatic surgery was 43.3%. On multivariable analysis, patients who resided in low-diversity areas had 16% lower odds of experiencing a TO following pancreatic resection compared with patients from high-diversity communities (OR 0.84, 95% CI 0.72–0.98). Compared with patients who resided in the high-diversity areas, individuals who lived in low-diversity areas had higher odds of 90-day readmission (OR 1.16, 95% CI 1.03–1.31) and had higher odds of dying within 90 days (OR 1.85, 95% CI 1.45–2.38) (both p < 0.05). Nonminority patients who resided in low-diversity areas also had a 14% decreased likelihood to achieve a TO after pancreatic resection compared with nonminority patients in high-diversity areas (OR 0.86, 95% CI 0.73–1.00). Conclusion Patients residing in the lowest racial/ethnic integrated counties were considerably less likely to have an optimal TO following pancreatic resection compared with patients who resided in the highest racially integrated counties. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10316-3.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Improved nurse‐to‐bed ratio may alleviate nurse workload and mitigate burnout, thus improving workplace satisfaction and performance 31 . Although not associated with TO in the current study, other structural measures such as hospital teaching status have been associated with TO 32,33 . Of note, the beneficial effect of these hospital “structural” factors were associated with improved odds of TO among both Magnet and non‐Magnet hospitals.…”

Section: Discussionmentioning

confidence: 54%

“…31 Although not associated with TO in the current study, other structural measures such as hospital teaching status have been associated with TO. 32,33 Of note, the beneficial effect of these hospital "structural" factors were associated with improved odds of TO among both Magnet and non-Magnet hospitals. In turn, patients undergoing HP surgery should focus on selecting hospitals that have strong structural measures in place to ensure "superior" clinical outcomes.…”

Section: Discussionmentioning

confidence: 97%

Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato‐pancreatic surgery for cancer

Mehta

Tsilimigras

Pawlik

2021

Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Background: The relationship between hospital Magnet status recognition and postoperative outcomes following complex cancer surgery remains ill-defined. We sought to characterize Textbook Outcome (TO) rates among patients undergoing (HP) surgery for cancer in Magnet versus non-Magnet centers. Methods: Medicare beneficiaries undergoing HP surgery between 2015 and 2017 were identified. The association of postoperative TO (no complications/extended length-of-stay/90-day mortality/90-day readmission) with Magnet designation was examined after adjusting for competing risk factors.

show abstract

“…A customized survey was created using TO criteria from previously published studies. 4,5,[10][11][12][13][14][15][16][17][18][19] Subjective factors such as pain control and cosmetic outcome were omitted from the finalized survey given their absence in past TO definitions. The survey consisted of three major sections.…”

Section: Methodsmentioning

confidence: 99%

“…[6][7][8][9] In this context, recent research has focused on the novel composite metric known as a "textbook outcome" (TO) to describe when all desired perioperative outcomes have been met. 4,5,[10][11][12][13][14][15][16][17][18][19] Since a TO includes the most important outcome parameters of the surgical process, it provides an objective overview of the overall quality of care.…”

Section: Introductionmentioning

confidence: 99%

Patient Perspectives on Defining Textbook Outcomes Following Major Abdominal Surgery

Wiseman

Sarna

Wills

et al. 2022

Journal of Gastrointestinal Surgery

Self Cite

View full text Add to dashboard Cite

Background The composite metric textbook outcome (TO) has recently gained interest as a novel quality measure. However, the criteria for defining a TO have not been rigorously defined and patient perspectives on the characteristics of TO are unknown. Methods Patients who underwent major abdominal surgery at a single tertiary care center were administered a customized survey designed to ascertain their perspectives on defining TOs. The relationship between patient-reported and clinically defined TO rates was compared. Results Among 79 patients who underwent gastrointestinal (51%), pancreatic (29%), hepatic (18%), or other major abdominal (3%) operations, 57% were female and 86% had an ASA class ≥3. Most patients underwent surgery for malignancy (87%) with 60% undergoing an open operation. Patients most commonly valued no mortality following surgery (96%), no reoperation (75%), and having a margin negative resection (73%) as "extremely important." In contrast, those outcomes that were most commonly valued as "not important at all" or "minimally important" were receiving a blood transfusion (24%) and not having any complications (13%). Using previously published criteria for TOs, 47 (60%) patients were classified as having a clinically defined TO; in contrast, 68 patients (86%) self-reported their outcome was textbook. Self-reported responses were concordant with clinically defined TO criteria 63% of the time (McNemar's test: S=15.2, p<0.01, evidence of disagreement). Conclusion There was significant discordance between patient-reported versus clinically defined measures of TOs, suggesting patients value other considerations beyond traditional factors when evaluating the success of their surgery. Future studies should delineate these relationships and incorporate these factors to refine TO definitions.

show abstract

Influence of hospital teaching status on the chance to achieve a textbook outcome after hepatopancreatic surgery for cancer among Medicare beneficiaries

Cited by 60 publications

References 38 publications

Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery

Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery

Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato‐pancreatic surgery for cancer

Patient Perspectives on Defining Textbook Outcomes Following Major Abdominal Surgery

Contact Info

Product

Resources

About