The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction

Leeds, Ira L.; Canner, Joseph K.; Efron, Jonathan E.; Ahuja, Nita; Haut, Elliott R.; Wick, Elizabeth C.; Johnston, Fabian M.

doi:10.1016/j.jss.2017.08.039

Cited by 17 publications

(14 citation statements)

References 38 publications

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“…They found that there was an increased likelihood of 30-day mortality (OR = 1.18, 95% CI = 1.10–1.28), complication rate (OR = 1.09, 95% CI = 1.07–1.11), and the total number of complications (OR = 1.08, 95% CI = 1.06–1.11) in patients undergoing surgery for cancer compared to benign lesions. 9 More patients in the Indian subset underwent major surgical procedures (65.7% vs 36%), and this may have been an additional factor associated with increased complication rate. Indian patients with complications were older, with ASA grade III and IV physical status, and underwent major surgeries, which are known risk factors for postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes Following Elective Surgery in India

Agarwal

Radhakrishnan

Shah

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Introduction The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis. We report postoperative outcomes in the Indian data set of patients following elective surgery. Materials and methods In this prospective 7-day observational study, after obtaining a waiver of informed consent, data were collected for 30 days from consecutive patients >18 years undergoing elective surgery. The primary outcome was in-hospital postoperative complications. The secondary outcomes were in-hospital all-cause mortality, the relationship between postoperative complications and admission to critical care, and the duration of hospital stay. Complications were graded as mild, moderate, and severe. Failure to rescue was defined as mortality in patients admitted to an intensive care unit (ICU) for the treatment of complications. Results Complications occurred in 57 (27.5%) patients, who were older (53 vs 47 years, p < 0.001) and had American Society of Anaesthesiologists grades III and IV physical status ( p = 0.029). One hundred and thirty-eight (65.7%) patients underwent a major surgical procedure of which 132 (62.8%) procedures were done for malignancy. Postoperative complications were significantly higher (41.5% vs 22.7%) in patients electively admitted to ICU. The overall mortality rate was 2.4%, whereas the mortality rate was 8.8% in those who developed complications. C onclusion We found that 28% of patients developed postoperative complications. The overall mortality was 2.4% but was higher (8.8%) in those who developed complications. Age and complex surgical procedures independently predicted complications, while lower preoperative hemoglobin appeared to be protective. Study Registration ISRCTN51817007 How to cite this article Agarwal V, Muthuchellappan R, Shah BA, Rane PP, Kulkarni AP, et al. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021;25(5):528–534.

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Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes Following Elective Surgery in India

Agarwal

Radhakrishnan

Shah

et al. 2021

Indian Journal of Critical Care Medicine

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“…Longer hospitalizations are also associated with iatrogenic and hospital-acquired sequelae that contribute to increased morbidity and mortality [8]. Preoperative hypoalbuminemia (albumin <3.5 g/dL), body weight loss (>10 percent decrease in body weight six months prior to surgery), body mass index <18.5 kg/m 2 , dialysis status, disseminated cancer, increasing frailty, non-Caucasian race, perioperative anemia, blood transfusion, increasing operative time, age, and American Society of Anesthesiologists (ASA) classification have all been associated with prolonged LOS for various abdominal and gynecological surgeries [9,10,11,12,13,14,15,16,17].…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

et al. 2019

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Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs.

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“…Intuitively a cancer diagnosis has been shown to be an independent risk factor for a poor patient outcome with the previous series showing the poor utility of the ACS‐NSQIP calculator to predict complications in patients with cancer 21 . Leeds et al 21 reviewed the treatment out of 264 401 patients, of which 111 563 had a history of cancer, cancer patients had worse an outcome in every measure, and having a diagnosis of cancer at the time of surgery lead to an 18% increased odds of death, a 9% increased odds of a complication, and an 8% increased odds of multiple complications 21 . When focusing only on the outcome of patients undergoing a total joint arthroplasty in the setting of cancer Sloan et al 18 analyzed over 500 000 patients and found that cancer patients were at significantly increased risk of death and postoperative complications 18 .…”

Section: Discussionmentioning

confidence: 99%

Utility of the ACS‐NSQIP surgical risk calculator in predicting postoperative complications in patients undergoing oncologic proximal femoral replacement

Labott

Brinkmann

Hevesi

et al. 2021

Journal of Surgical Oncology

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Introduction Proximal femur replacement (PFR) in the setting of tumor resection is associated with a high rate of postoperative complication. The online American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) surgical risk calculator is approved by the Center of Medicare and Medicaid services to estimate 30‐day postoperative complications. This study was to determine if the ACS‐NSQIP can predict postoperative complications following PFR. Methods We reviewed 103 (61 male and 42 female) patients undergoing PFR using the Current Procedural Terminology (CPT) codes available in the calculator: 27125 (hemiarthroplasty), 27130 (total hip), 27132 (conversion to total hip), 27134 (revision total hip), 27137 (revision acetabulum), 27138 (revision femur), and 27365 (excision tumor hip). The predicted rates of complications were compared with the observed rates. Results Complications occurred in 54 (52%) of patients, with the predicted risk based on CPT codes: 27125 (21.5%); 27130 (7.8%); 27132 (16.6%), 27134 (17.8%), 27137 (14.4%), 274138 (22.7%), and 27365 (16.2%). The calculator was a poor predictor of complications (27125, area under the curve [AUC] 0.576); (27130, AUC 0.489); (27132, AUC 0.490); (27134, AUC 00.489); (27137, AUC 0.489); (27138, AUC 0.471); and (27365, AUC 0.538). Conclusion Oncologic PFR is known for complications. The ACS‐NSQIP does not adequately predict the incidence of complications, and therefore cannot reliably be used in their shared decision‐making process preoperative.

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The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction

Cited by 17 publications

References 38 publications

Postoperative Outcomes Following Elective Surgery in India

Postoperative Outcomes Following Elective Surgery in India

Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery

Utility of the ACS‐NSQIP surgical risk calculator in predicting postoperative complications in patients undergoing oncologic proximal femoral replacement

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