Predicting Postoperative Destination Through Preoperative Evaluation in Elective Open Aortic Aneurysm Repair

Boitano, Laura T.; Iannuzzi, James C.; Tanious, Adam; Mohebali, Jahan; Schwartz, Samuel I.; Clouse, W. Darrin; Conrad, Mark F.

doi:10.1016/j.jss.2018.10.039

Cited by 15 publications

(5 citation statements)

References 36 publications

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“…9,10 Major complications included postoperative venous thromboembolism, renal injury and failure, sepsis, deep tissue infection, failure to wean off of ventilator, reintubation, pneumonia, stroke, cardiac arrest, myocardial infarction, bleeding, and return to the operating room. 11 All variables utilized had <10% of data missing. Missing data were grouped with the referent group to create a conservative estimate for all independent variables.…”

Section: Data Source and Cohortmentioning

confidence: 99%

Patient complexity by surgical specialty does not correlate with work relative value units

Ramirez

Gasper

Seib

et al. 2020

Surgery

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Background: Understanding the differences in how patient complexity varies across surgical specialties can inform policy decisions about appropriate resource allocation and reimbursement. This study evaluated variation in patient complexity across surgical specialties and the correlation between complexity and work relative value units. Study design: The 2017 American College of Surgeons National Surgical Quality Improvement Program was queried for cases involving otolaryngology and general, neurologic, vascular, cardiac, thoracic, urologic, orthopedic, and plastic surgery. A total of 10 domains of patient complexity were measured: American Society of Anesthesiologists class 4, number of major comorbidities, emergency operation, major complications, concurrent procedures, additional procedures, length of stay, non-home discharge, readmission, and mortality. Specialties were ranked by their complexity domains and the domains summed to create an overall complexity score. Patient complexity then was evaluated for correlation with work relative value units. Results: Overall, 936,496 cases were identified. Cardiac surgery had the greatest total complexity score and was most complex across 4 domains: American Society of Anesthesiologists class 4 (78.5%), 30-day mortality (3.4%), major complications (56.9%), and mean length of stay (9.8 days). Vascular surgery had the second greatest complexity score and ranked the greatest on the domains of major comorbidities (2.7 comorbidities) and 30-day readmissions (10.1%). The work relative value units did not correlate with overall complexity score (Spearman's r ¼ 0.07; P < .01). Although vascular surgery had the second most complex patients, it ranked fifth greatest in median work relative value units. Similarly, general surgery was the fifth most complex but had the second-least median work relative value units. Conclusion: Substantial differences exist between patient complexity across specialties, which do not correlate with work relative value units. Physician effort is determined largely by patient complexity, which is not captured appropriately by the current work relative value units.

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Section: Data Source and Cohortmentioning

confidence: 99%

Patient complexity by surgical specialty does not correlate with work relative value units

Ramirez

Gasper

Seib

et al. 2020

Surgery

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“…Boitano et al found that several factors including functional status, are associated with nonhome discharge. 12 Arya et al demonstrated that preoperative frailty increases risk of nonhome discharge in patients who underwent vascular surgery. 5 As a result, several studies have proposed interventions to improve functional status to subsequently improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Our study findings in this large national cohort are similar to previous smaller studies. Boitano et al found that several factors including functional status, are associated with nonhome discharge 12 . Arya et al demonstrated that preoperative frailty increases risk of nonhome discharge in patients who underwent vascular surgery 5 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative functional status is associated with discharge to nonhome in geriatric individuals

Hung

Wolf

D’Adamo

et al. 2021

J American Geriatrics Society

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Introduction Discharging older individuals to rehabilitation facilities is associated with adverse outcomes, including readmission or increased mortality rate. As preoperative functional status is an important factor impacting patient outcome, we hypothesized that this would be associated with patient disposition to nonhome locations. Materials and Methods A retrospective analysis was performed using data from the 2013–2018 American College of Surgeons National Surgical Quality Improvement Program, including targeted variables from the Geriatric Pilot Project. Patients aged 65 and older in 33 institutions across the nation were included (n = 44,219). Preoperative functional status was categorized as independent, partially dependent, and dependent. The primary outcome was home versus nonhome disposition. Nonhome was defined as rehabilitation facility and nursing home. Descriptive analyses were performed. Variables associated with postoperative discharge to nonhome were identified using logistic regression. Results The largest percentage of operations was orthopedics (40.8%), followed by general surgery (29.2%) and vascular operations (10.0%). The majority of the patients were independent before operations (93.1% independent, 6% partially dependent, and 0.9% totally dependent). In regression analyses, patients who were partially dependent preoperatively had five times higher odds of discharging to nonhome, compared to patients who were independent (odds ratio [OR] 5.04, p < 0.01). Similarly, patients who were totally dependent had 3.2 higher odds of discharging to nonhome than patients who were independent (OR 3.22, p < 0.01). Conclusion Better preoperative functional status is associated with patient discharge to home in older adults. Preoperative interventions aimed at improving functional status, such as prehabilitation, may be beneficial in improving patient outcomes.

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“…Risk factors for nonhome discharge (NHD) have been reported for select surgeries in the surgical literature, such as total joint arthroplasty, anterior cervical discectomy and fusion, posterior cervical fusion, colectomy, pancreatectomy, and open abdominal aortic aneurysm repair (Boitano et al, 2019;Di Capua et al, 2017;Keswani et al, 2016;Sacks et al, 2015;Ye et al, 2018). However, they have not been examined broadly across all surgical subspecialties, especially using population-based data.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery

et al. 2020

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To identify patient risk factors for nonhome discharge (NHD) for home-dwelling older patients undergoing surgery, we performed a retrospective cohort study of patients aged ≥65 years undergoing elective surgery between 2014 and 2016 using the geriatric research file from the National Surgical Quality Improvement Program (NSQIP). Multivariable logistic regression examined the association between preoperative demographics, comorbidities, and functional status and NHD to determine which factors are most strongly predictive of NHD. Risk of NHD was higher among those of age >85 years, age 75 to 85 years, Black race, with body mass index (BMI) >30, dyspnea with exertion or at rest, partially or totally dependent in activities of daily living (ADLs), preoperative steroid use, preoperative wound infection, use of a mobility aid, fall within 3 months, or living alone at home without support. NHDs were statistically more likely among orthopedic, neurosurgery, or cardiac surgery interventions. Understanding individual patient’s risks and setting expectations for likely postoperative course is integral to appropriate preoperative counseling and preoperative optimization.

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Predicting Postoperative Destination Through Preoperative Evaluation in Elective Open Aortic Aneurysm Repair

Cited by 15 publications

References 36 publications

Patient complexity by surgical specialty does not correlate with work relative value units

Patient complexity by surgical specialty does not correlate with work relative value units

Preoperative functional status is associated with discharge to nonhome in geriatric individuals

Preoperative Risk Factors for Nonhome Discharge of Home-Dwelling Geriatric Patients Following Elective Surgery

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