Limitations of ACS‐NSQIP in Reporting Complications for Patients Undergoing Pancreatectomy: Underscoring the Need for a Pancreas‐Specific Module

Epelboym, Irene; Gawlas, Irmina; Lee, James A.; Schrope, Beth; Chabot, John A.; Allendorf, John D.

doi:10.1007/s00268-013-2439-1

Cited by 77 publications

(54 citation statements)

References 34 publications

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“…(35, 36) As mentioned earlier, it has been shown that up to 20% of a well-educated population is unable to identify if 1%, 5% or 10% is a greater risk. (28) Goldman’s index, developed in 1977, was one of the first tools to predict percentage chance of a postoperative complication (in this case cardiac risk).…”

Section: Discussionmentioning

confidence: 96%

Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator

Cusworth

Krasnick

Nywening

et al. 2017

HPB

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Background The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator was developed to help counsel patients regarding estimated postoperative risk for a variety of surgical complications. This retrospective single institutional study examined the calculator’s ability to accurately predict complications and length of hospital stay (LOS) in patients who had undergone a Pancreaticoduodenectomy (PD) at our institution. Methods 165 patients at Washington University School of Medicine who underwent a PD from 8/2011 to 7/2013 were included. Surgical complication risk as determined by the ACS-NSQIP Surgical Risk Calculator were compared to actual 30 day complications. PD complications not accounted for by the calculator were compared to those without PD-specific complications. Results Overall predicted LOS was significantly shorter than actual duration of hospitalization (median 8.5 vs 8.0 days; p <0.001). 38% patients (n=62) with Whipple-specific complication demonstrated a significant increase in LOS (8.0 vs. 12.2 days; p<0.0001). Discussion A large proportion of complications experienced after PD are pancreas-specific, accounting for the difference in predicted vs actual LOS and providing rationale for future development of PD specific risk models.

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Section: Discussionmentioning

confidence: 96%

Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator

Cusworth

Krasnick

Nywening

et al. 2017

HPB

View full text Add to dashboard Cite

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“…Advances in data collection and process management driven within the surgical community by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) have led to increased awareness of perioperative morbidity and development of programs to improve patient-specific outcomes. Recent improvements in NSQIP include the addition of targeted modules for certain disease groups, including hepatobiliary, vascular, and colorectal among others, as well as more granular data abstraction to better highlight procedure-specific complications and risk factors (4, 5). Despite data suggesting considerable morbidity, gastrointestinal operations have not been the focus of recent targeted NSQIP improvement (6).…”

Section: Introductionmentioning

confidence: 99%

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Martin

Das

Turrentine

et al. 2016

Journal of Gastrointestinal Surgery

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Background Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy. Methods This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission and reoperation. Results 3,678 patients underwent gastrectomy. A majority of patients had distal gastrectomy (N= 2,799, 76.1%) and had resection for malignancy (N= 2,316, 63.0%). 798 patients (21.7%) experienced a major complication. Reoperation was required in 290 patients (7.9%). 30-day mortality was 5.2%. Age (OR=1.01, 95% CI: 1.01–1.02, p=0.001), preoperative malnutrition (OR=1.65, 95% CI: 1.35–2.02, p<0.001), total gastrectomy (OR=1.63, 95% CI: 1.31–2.03, p<0.001), benign indication for resection (OR=1.60, 95% CI: 1.29–1.97, p<0.001), blood transfusion (OR=2.57, 95% CI: 2.10–3.13, p<0.001), and intraoperative placement of a feeding tubes (OR=1.28, 95% CI: 1.00–1.62, p=0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR=1.23, 95% CI: 0.99–1.53, p=0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p<0.001). Conclusions Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

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“…As a result, key outcome measures for certain operations are not captured by ACS NSQIP (15-18). An example of this limitation is pancreatic fistula following pancreatectomy.…”

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confidence: 99%

Is American College of Surgeons NSQIP Organ Space Infection a Surrogate for Pancreatic Fistula?

Parikh

Beane

Kilbane

et al. 2014

Journal of the American College of Surgeons

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Structured Abstract Background In the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pancreatic fistula has not been monitored, although organ space infection (OSI) data are collected. Therefore, the purpose of this analysis was to determine the relationship between ACS NSQIP organ space infection and pancreatic fistulas. Study Design From 2007-11, 976 pancreatic resection patients were monitored via ACS NSQIP at our institution. From this database, 250 patients were randomly chosen for further analysis. Four patients were excluded because they underwent total pancreatectomy. Data on OSI were gathered prospectively. Data on pancreatic fistulas and other intra-abdominal complications were determined retrospectively. Results Organ space infections (OSIs) were documented in 22 patients (8.9%). Grade B (n=26) and C (n=5) pancreatic fistulas occurred in 31 patients (12.4%) while Grade A fistulas were observed in 38 patients (15.2%). Bile leaks and gastrointestinal (GI) anastomotic leaks each developed in five (2.0%) patients. Only 17 of 31 Grade B and C pancreatic fistulas (55%), and none of 38 Grade A fistulas were classified as OSIs in ACS NSQIP. In addition, only two of five bile leaks (40%) and two of five GI anastomotic leaks (40%) were OSIs. Moreover, three OSIs were due to bacterial peritonitis, a chyle leak and an ischemic bowel. Conclusions This analysis suggests that the sensitivity (55%) and specificity (45%) of Organ Space Infection (OSI) in ACS NSQIP are too low for OSI to be a surrogate for Grade B and C pancreatic fistulas. We conclude that procedure-specific variables will be required for ACS NSQIP to improve outcomes following pancreatectomy.

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Limitations of ACS‐NSQIP in Reporting Complications for Patients Undergoing Pancreatectomy: Underscoring the Need for a Pancreas‐Specific Module

Cited by 77 publications

References 34 publications

Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator

Whipple-specific complications result in prolonged length of stay not accounted for in ACS-NSQIP Surgical Risk Calculator

Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors

Is American College of Surgeons NSQIP Organ Space Infection a Surrogate for Pancreatic Fistula?

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