Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment, Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus

Cohen, Mark E.; Ko, Clifford Y.; Bilimoria, Karl Y.; Zhou, Lei; Huffman, Kristopher M.; Wang, Xue; Liu, Yaoming; Kraemer, Kari; Meng, Xiangju; Merkow, Ryan P.; Chow, Warren B.; Matel, Brian; Richards, Karen; Hart, Amy J.; Dimick, Justin B.; Hall, Bruce L.

doi:10.1016/j.jamcollsurg.2013.02.027

Cited by 493 publications

(298 citation statements)

References 43 publications

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“…[15][16][17][18] The ACS-NSQIP database lacks cancer-specific variables, which may result in uncontrolled confounding, and this could in turn result in an over-or underestimate of the effect of blood transfusions on perioperative morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17][18] Patients' demographic and clinical characteristics and their treatment details were collected from the gastrectomy admission records in the ACS-NSQIP database. The extent of surgery was defined according to CPT codes, and procedures were subdivided into total gastrectomy (CPT 43620, 43621 and 43622), subtotal gastrectomy (CPT 43631, 43632, 43633 and 43634) and multivisceral resection (CPT 38120, 38102 and 38129 for splenectomy; 44140, 44141 and 44160 for colectomy; 48146, 48145 and 48140 for pancreatectomy; 44121, 44120 and 44125 for enterectomy; 47100, 47120 and 47122 for hepatectomy; and 43124, 43117, 43118, 43101, 43121, 43122 and 43123 for esophagectomy).…”

Section: Data Sourcesmentioning

confidence: 99%

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The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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Background: Red blood cell transfusions (RBCT) carry risk of transfusion-related immunodulation that may impact postoperative recovery. This study examined the association between perioperative RBCT and short-term postoperative outcomes following gastrectomy for gastric cancer. Methods:Using the American College of Surgeons National Surgical Quality Improvement Program database, we compared outcomes of patients (transfused v. nontransfused) undergoing elective gastrectomy for gastric cancer (2007)(2008)(2009)(2010)(2011)(2012). Outcomes were 30-day major morbidity, mortality and length of stay. The association between perioperative RBCT and outcomes was estimated using modified Poisson, logistic, or negative binomial regression. Results:Of the 3243 patients in the entire cohort, we included 2884 patients with nonmissing data, of whom 535 (18.6%) received RBCT. Overall 30-day major morbidity and mortality were 20% and 3.5%, respectively. After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased 30-day mortality (relative risk [RR] 3.1, 95% confidence interval [CI] 1.9-5.0), major morbidity (RR 1.4, 95% CI 1.2-1.8), length of stay (RR 1.2, 95% CI 1.1-1.2), infections (RR 1.4, 95% CI 1.1-1.6), cardiac complications (RR 1.8, 95% CI 1.0-3.2) and respiratory failure (RR 2.3, 95% CI 1.6-3.3). Conclusion:Red blood cell transfusions are associated with worse postoperative short-term outcomes in patients with gastric cancer. Blood management strategies are needed to reduce the use of RBCT after gastrectomy for gastric cancer.Contexte : Les transfusion de globules rouges (TGR) entrainent une immunosuppression qui peut entraver la récupération post-opératoire. Cette étude évalue l'association entre les TGR péri-opératoires et l'issue post-opératoire après gastrectomie pour cancer gastrique (CG). Conclusion :Les TGR sont associées à une détérioration de l'issue post-opératoire après gastrectomie pour CG, dont la morbidité majeure, la mortalité, et la durée d'hospitalisation. Des stratégies multidisciplinaires de gestion du risque transfusionnel sont nécessaires afin de limiter l'utilisation des TGRs après gastrectomie pour CG.

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Section: Discussionmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

et al. 2016

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“…The accuracy of documentation of clinical diagnoses, comorbidities, and complications collected in any database can be limited by errors in data entry. However, previous studies of the ACS-NSQIP 1 database have shown excellent accuracy and quality control because the database relies on clinical data from patients' medical charts gathered by skilled reviewers and does not rely on administrative claims or billing information [9,10,15,20]. The integrity of data collected is scrutinized through site visits at participating institutions, conference calls, an annual meeting of participants, and regular auditing.…”

Section: Discussionmentioning

confidence: 99%

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Jiang

Somogyi

Patel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories. Questions/purposes We asked: (1) Is obesity associated with an increased risk of complications within 30 days of primary TSA? (2) Is obesity associated with increased operative time? Methods The American College of Surgeons National Surgical Quality Improvement Program 1 database for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder. The ACS-NSQIP 1 database was selected for this study as it is a nationally representative database that provides prospectively collected perioperative data and a comprehensive patient medical profile. Exclusion criteria included revision TSA, infection, tumor, or fracture. We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder. Patients who underwent a TSA were divided in four BMI categories: normal (18.5-25 kg/m 2 ), overweight (25-30 kg/m 2 ), obesity Class 1 (30-35 kg/m 2 ), and obesity Class 2 or greater ([ 35 kg/m 2 ). Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes. Differences in patient demographics, preoperative laboratory values, and preexisting patient comorbidities also were analyzed among different BMI groups, and multivariate analysis was used to adjust for any potential confounding variables.

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“…2,3 As a result, an emphasis has been placed on considering reliability when selecting outcome measures. 4,5,[14][15][16] In contrast to other clinical outcome measures, we have demonstrated that episode payments are more reliable and many hospitals meet commonly accepted reliability benchmarks, even for less common procedures such as pancreatectomy. This is due to the fact that every hospital admission has an associated episode payment, whereas adverse clinical outcomes, (i.e.…”

Section: Discussionmentioning

confidence: 89%

Reliability of Hospital Cost-Profiles in Inpatient Surgery

Grenda

Krell

Dimick

2014

Journal of Surgical Research

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Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment, Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus

Cited by 493 publications

References 43 publications

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

Reliability of Hospital Cost-Profiles in Inpatient Surgery

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