Colectomy Performance Improvement within NSQIP 2005–2008

Ozhathil, Deepak K.; Li, YouFu; Smith, Jillian K.; Witkowski, Elan R.; Coyne, Elizaveta Ragulin; Alavi, Karim; Tseng, Jennifer F.; Shah, Shimul A.

doi:10.1016/j.jss.2011.06.052

Cited by 31 publications

(11 citation statements)

References 11 publications

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“…Several other researchers also reported a similar observation using the same NIS database, or other databases such as the Premier Inc, or the National Surgical Quality Improvement Program 14, 17, 41, 42 . However, we have a novel finding in the year 2012, which is the confidence limits for the weighted number of laparoscopic colorectal surgeries start to cross with the confidence limits of the weighted number of open colorectal surgeries.…”

Section: Discussionmentioning

confidence: 54%

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Lee

Chiu

Wang

et al. 2017

Sci Rep

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Limited data are available for the epidemiology and outcome of colorectal cancer in relation to the three main surgical treatment modalities (open, laparoscopic and robotic). Using the US National Inpatient Sample database from 2004 to 2012, we identified 1,265,684 hospitalized colorectal cancer patients. Over the 9 year period, there was a 13.5% decrease in the number of hospital admissions and a 43.5% decrease in in-hospital mortality. Comparing the trend of surgical modalities, there was a 35.4% decrease in open surgeries, a 3.5 fold increase in laparoscopic surgeries, and a 41.3 fold increase in robotic surgeries. Nonetheless, in 2012, open surgery still remained the preferred surgical treatment modality (65.4%), followed by laparoscopic (31.2%) and robotic surgeries (3.4%). Laparoscopic and robotic surgeries were associated with lower in-hospital mortality, fewer complications, and shorter length of stays, which might be explained by the elective nature of surgery and earlier tumor grades. After excluding patients with advanced tumor grades, laparoscopic surgery was still associated with better outcomes and lower costs than open surgery. On the contrary, robotic surgery was associated with the highest costs, without substantial outcome benefits over laparoscopic surgery. More studies are required to clarify the cost-effectiveness of robotic surgery.

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Section: Discussionmentioning

confidence: 54%

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Lee

Chiu

Wang

et al. 2017

Sci Rep

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“…5,11-16 We demonstrated an overall rate of LAC use of 45% during the study period, with an increase from 42% to 48% between 2009 and 2011; these are higher than rates published from NSQIP in 2008 (34%), but similar to those from the Nationwide Inpatient Sample in 2009 (42.6%). 7,17 An important consideration for this difference is the use of Common Procedural Terminology (CPT) codes in NSQIP and ICD-9 procedure codes in the Nationwide Inpatient Sample and UHC. We showed higher rates of laparoscopy use for HVS and MVS compared with LVS.…”

Section: Discussionmentioning

confidence: 99%

“…5 Even though the use of laparoscopy has steadily increased over time, 3 it is still offered to only a minority of patients with CRC. 6,7 …”

mentioning

confidence: 99%

Surgeon Volume and Elective Resection for Colon Cancer: An Analysis of Outcomes and Use of Laparoscopy

Damle

Macomber

Flahive

et al. 2014

Journal of the American College of Surgeons

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BACKGROUND Surgeon volume may be an important predictor of quality and cost outcomes. We evaluated the association between surgeon volume and quality and cost of surgical care in patients with colon cancer. STUDY DESIGN We performed a retrospective study of patients who underwent resection for colon cancer, using data from the University HealthSystem Consortium from 2008 to 2011. Outcomes evaluated included use of laparoscopy, ICU admission, postoperative complications, length of stay, and total direct hospital costs by surgeon volume. Surgeon volume was categorized according to high (HVS), medium (MVS), and low (LVS) average annual volumes. RESULTS A total of 17,749 patients were included in this study. The average age of the cohort was 65 years and 51% of patients were female. After adjustment for potential confounders, compared with LVS, HVS and MVS were more likely to use laparoscopy (HVS, odds ratio [OR] 1.27, 95% CI 1.15, 1.39; MVS, OR 1.16 95% CI 1.65, 1.26). Postoperative complications were significantly lower in patients operated on by HVS than LVS (OR 0.77 95% CI 0.76, 0.91). The HVS patients were less likely to require reoperation than those in the LVS group (OR 0.70, 95% CI 0.53, 0.92) Total direct costs were $927 (95% CI −$1,567 to −$287) lower in the HVS group compared with the LVS group. CONCLUSIONS Higher quality, lower cost care was achieved by HVS in patients undergoing surgery for colon cancer. An assessment of differences in processes of care by surgeon volume may help further define the mechanism for this observed association.

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“…One example of this relates to colectomies performed in ACS-NSQIP enrolled hospitals. These operations have been shown to increasingly be performed laparoscopically in these hospitals, with significant reductions in most major complications (including surgical-site infections, pneumonia and sepsis) [51]. One should remember despite the potential benefits of the ACS-NSQIP programme that there are limits to its usefulness.…”

Section: Risk Predictionmentioning

confidence: 99%

Clinical review: Can we predict which patients are at risk of complications following surgery?

Shah

Hamilton

2013

Crit Care

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There are a vast number of operations carried out every year, with a small proportion of patients being at highest risk of mortality and morbidity. There has been considerable work to try and identify these high-risk patients. In this paper, we look in detail at the commonly used perioperative risk prediction models. Finally, we will be looking at the evolution and evidence for functional assessment and the National Surgical Quality Improvement Program (in the USA), both topical and exciting areas of perioperative prediction.

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Colectomy Performance Improvement within NSQIP 2005–2008

Cited by 31 publications

References 11 publications

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Trends and Outcomes of Surgical Treatment for Colorectal Cancer between 2004 and 2012- an Analysis using National Inpatient Database

Surgeon Volume and Elective Resection for Colon Cancer: An Analysis of Outcomes and Use of Laparoscopy

Clinical review: Can we predict which patients are at risk of complications following surgery?

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