Preoperative Albumin Alone is Not a Predictor of 30-Day Outcomes in Pressure Ulcer Patients

Lim, Seokchun; Kim, Bobby D.; Kim, John Y.S.; Halen, Jon P. Ver

doi:10.1097/sap.0000000000000124

Cited by 7 publications

(13 citation statements)

References 38 publications

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“…Low albumin has been noted as an indicator of a patient’s overall medical fitness, in the context of malnutrition. Contrary to a previous study that found low albumin not being associated with worse 30-day outcomes in pressure ulcer management [ 13 ], our findings show it as a risk factor for overall complications and specifically, wound dehiscence. This difference in findings may be related to the nonspecific nature of the marker, our patient cohort consisting of only flap reconstruction, or variability in methodology.…”

Section: Discussioncontrasting

confidence: 99%

National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

et al. 2018

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BackgroundComplication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers.MethodsData from the NSQIP database (2005–2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications.ResultsThere were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications.ConclusionsDespite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

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Section: Discussioncontrasting

confidence: 99%

National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

et al. 2018

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“…34 Also, patients with low preoperative albumin were almost twice as likely to have wound complications after laryngectomy, although the relationship between hypoalbuminemia and AEs is debated. 17 On regression analysis, weight loss was ratelinked to medical complications in our study, but not to surgical complications (data not shown). It is possible that malnourished patients are triaged to more aggressive reconstructive techniques (e.g., pedicled and free flaps), thus compensating for their baseline poor physiologic reserve.…”

Section: Discussionmentioning

confidence: 52%

“…Dyspnea may serve as a gross marker for overall poor health, presenting as a single common finding among a constellation of medical comorbidities in patients with overall poor health. [15][16][17] NSQIP defines dyspnea as "The patient describes difficult, painful, or labored breathing. "…”

Section: Discussionmentioning

confidence: 99%

Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006–2011 National Surgical Quality Improvement Program (NSQIP) Database

et al. 2017

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While neck dissection is an important primary and adjunctive procedure in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed to identify factors associated with adverse events (AEs) in patients undergoing neck dissection. A total of 619 patients were identified, using CPT codes specific to neck dissection. Of the 619 patients undergoing neck dissection, 142 (22.9%) experienced an AE within 30 days of the surgical procedure. Risk factors on multivariate regression analysis associated with increased AEs included dyspnea (odds ratio [OR] 2.57; 95% confidence interval [CI] 1.06 to 6.22; p = 0.037), previous cardiac surgery (OR 3.38; 95% CI 1.08 to 10.52; p = 0.036), increasing anesthesia time (OR 1.005; 95% CI 1 to 1.009; p = 0.036), and increasing total work relative value units (OR 1.09; CI 1.04 to 1.13; p < 0.001). The current study is the largest, most robust analysis to identify specific risk factors associated with AEs after neck dissection. This information will assist with preoperative optimization, patient counseling, and appropriate risk stratification, and it can serve as benchmarking for institutions comparing surgical outcomes.

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“…After applying the full inclusion and exclusion criteria, a consensus was made for the discrepancies and 106 studies were eligible for analysis. 2,8,12 …”

Section: Resultsmentioning

confidence: 99%

Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research

Augustine

Najarali

et al. 2018

Plast Surg (Oakv)

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Background: The National Surgical Quality Improvement Program (NSQIP) is a robust, high-quality surgical outcomes database that measures risk-adjusted 30-day outcomes of surgical interventions. The purpose of this scoping review is to describe how the NSQIP is being used in plastic surgery research. Methods: A comprehensive electronic literature search was completed in PubMed, Embase, MEDLINE, and CINAHL. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. Articles were included if they utilized NSQIP data to conduct research in a domain of plastic surgery or analyzed surgical procedures completed by plastic surgeons. Extracted information included the domain of plastic surgery, country of origin, journal, and year of publication. Results: A total of 106 articles met the inclusion criteria. The most common domain of plastic surgery was breast reconstruction representing 35% of the articles. Of the 106 articles, 95% were published within the last 5 years. The Plastic and Reconstructive Surgery journal published most of the (59%) NSQIP-related articles. All of the studies were retrospective. Of note, there were no articles on burns and only one study on trauma as the domain of plastic surgery. Conclusion: This scoping review describes how NSQIP data are being used to analyze plastic surgery interventions and outcomes in order to guide quality improvement in 106 articles. It demonstrates the utility of NSQIP in the literature, however also identifies some limitations of the program as it applies to plastic surgery. Résumé Historique : Le Programme national d'amélioration de la qualité des soins chirurgicaux (PNAQC) est une base de données des résultats chirurgicaux à la fois solide et de qualité, qui mesure les résultats des interventions chirurgicales rajustées au risque au bout de 30 jours. La présenteétude exploratoire vise à décrire le mode d'utilisation du PNAQC dans la recherche en chirurgie plastique. Méthodologie : Les chercheurs ont procédé à une analyse bibliographiqueélectronique fouillée dans PubMed, Embase, MEDLINE et CINAHL. À l'aide de critères d'inclusion prédéfinis, deux analystes ont examiné des articles de manière indépendante pour en déterminer la pertinence. Ils ont inclus les articles qui utilisaient les données du PNAQC pour mener des recherches dans un domaine de la chirurgie plastique ou analyser les interventions chirurgicales effectuées par des plasticiens. L'information extraite incluait le domaine de la chirurgie plastique, le pays d'origine, la revue scientifique et l'année de publication. Résultats : Au total, 106 articles respectaient les critères d'inclusion. Le principal domaine de chirurgie plastiqueétait la reconstruction mammaire, qui représentait 35 % des articles. Des 106 articles, 95 % avaientété publiés au cours des cinq années précédentes. La revue Plastic and Reconstructive Surgery avait publié la plupart des articles liés au PNAQC (59 %). Toutes lesétudes

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Preoperative Albumin Alone is Not a Predictor of 30-Day Outcomes in Pressure Ulcer Patients

Cited by 7 publications

References 38 publications

National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program

Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006–2011 National Surgical Quality Improvement Program (NSQIP) Database

Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research

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