Effect of Cancer Surgery Complexity on Short-Term Outcomes, Risk Predictions, and Hospital Comparisons
Effect of Cancer Surgery Complexity on Short-Term Outcomes, Risk Predictions, and Hospital Comparisons
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DOI：
10.1016/j.jamcollsurg.2013.05.015
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发表时间：
2013-10-01
影响因子：
5.2
通讯作者：
Bilimoria, Karl Y.
中科院分区：
文献类型：
--
作者：
Merkow, Ryan P.;Bentrem, David J.;Bilimoria, Karl Y.
背景：存在的问题是，仅通过初次手术代码无法充分捕获肿瘤手术的复杂性。我们的目的是描述二次手术和30天的结果之间的关联，评估手术复杂性对风险预测的影响，并评估手术复杂性对医院质量comparison. Study设计的影响：接受结肠，直肠或胰腺癌切除术（2007-2011）的患者从美国外科医师学会NSQIP。通过使用二级程序代码和使用总工作相对值单位创建分类复杂性变量来评估复杂性。回归方法被用来评估手术的复杂性和医院的质量comparison.RESULTS：患者至少有一个二次手术记录在48.0%的结肠，55.5%的直肠，63.1%的胰腺病例。在几乎所有评估的并发症中，手术复杂性变量与不良结局相关。例如，结肠切除术联合同步肝切除术（比值比= 1.39; 95% CI，1.10-1.76）和胰腺切除术联合血管重建术（比值比= 1.21; 95% CI，1.01-1.45）后严重发病率增加。基于辨别力改善指数和似然比检验，通过增加二级手术复杂性变量以及总工作相对价值单位，对几乎所有评估的手术和结局进行了基于模型的预测。与二次手术类别的模型相比，包括总工作相对价值单位的模型具有相似或略好的区分度。复杂性adjustment.CONCLUSIONS：手术复杂性调整是可行的，并提高了风险估计30天的结肠，直肠和胰腺癌切除术后的结果。肿瘤特异性风险调整模型应包括使用二次手术代码的复杂性调整。(C)2013年美国外科医生学会
BACKGROUND: Concern exists that oncologic surgical complexity is not adequately captured by the primary procedure code alone. Our objectives were to characterize the association between secondary procedures and 30-day outcomes, evaluate the effect of surgical complexity on risk predictions, and assess the influence of surgical complexity on hospital-quality comparisons.STUDY DESIGN: Patients who underwent colon, rectal, or pancreatic resection for cancer (2007-2011) were identified from theAmerican College of Surgeons NSQIP. Complexity was assessed by creating categorical complexity variables using secondary procedure codes and using total work relative value units. Regression methods were used to evaluate surgical complexity and hospital-quality comparisons.RESULTS: Patients had at least one secondary procedure documented in 48.0% of colon, 55.5% of rectal, and 63.1% of pancreatic cases. Surgical complexity variables were associated with worse outcomes across nearly all complications assessed. For example, serious morbidity was increased after an index colon resection with a synchronous liver resection (odds ratio = 1.39; 95% CI, 1.10-1.76) and a pancreatic resection with vascular reconstruction (odds ratio = 1.21; 95% CI, 1.01-1.45). Based on discrimination improvement indices and the likelihood ratio test, model-based predictions were enhanced with the addition of secondary surgical complexity variables, as well as total work relative value units, for nearly all procedures and outcomes assessed. Models that included total work relative value units had similar or marginally better discrimination compared with models with secondary procedure categories. Hospital performance did not change substantially after complexity adjustment.CONCLUSIONS: Surgical complexity adjustment is feasible and improves risk estimation of 30-day postoperative outcomes for colon, rectal, and pancreatic resections for cancer. Oncology-specific risk-adjustment models should include complexity adjustment using secondary procedure codes. (C) 2013 by the American College of Surgeons