Simplified preoperative tool predicting discharge destination after major oncologic gastrointestinal surgery

Ramanathan, R. K.; Rieser, Caroline; Kurtom, Saba; Rustom, Salem; Subramany, Revathy; Wolfe, Luke

doi:10.1002/jso.25767

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…In this regard, stroke medicine is behind other specialties; these data have been used effectively in gastrointestinal surgery to predict discharge destination following resection of malignancy. 21 The modified Rankin Scale (mRS) is a recognised measure of functional disability and it has a strong correlation with the Rockwood frailty index. 22 The mRS and the National Institutes of Health Stroke Scale (NIHSS) are recorded for all stroke patients presenting in England, Wales and Northern Ireland as part of the Stroke Sentinel National Audit Programme (SSNAP).…”

Section: Introductionmentioning

confidence: 99%

Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward

Berker

Aung

et al. 2021

Clinical Medicine

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Background and rationaleReliable prediction of discharge destination in acute stroke informs discharge planning and can determine the expectations of patients and carers. There is no existing model that does this using routinely collected indices of pre-morbid disability and stroke severity. MethodsAge, gender, pre-morbid modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) were gathered prospectively on an acute stroke unit from 1,142 consecutive patients. A multiclass random forest classifier was used to train and validate a model to predict discharge destination. ResultsUsed alone, the mRS is the strongest predictor of discharge destination. The NIHSS is only predictive when combined with our other variables. The accuracy of the final model was 70.4% overall with a positive predictive value (PPV) and sensitivity of 0.88 and 0.78 for home as the destination, 0.68 and 0.88 for continued inpatient care, 0.7 and 0.53 for community hospital, and 0.5 and 0.18 for death, respectively. ConclusionPre-stroke disability rather than stroke severity is the strongest predictor of discharge destination, but in combination with other routinely collected data, both can be used as an adjunct by the multidisciplinary team to predict discharge destination in patients with acute stroke.

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Section: Introductionmentioning

confidence: 99%

Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward

Berker

Aung

et al. 2021

Clinical Medicine

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“…100–103 Other instruments used were reported in ≤3 studies. 17,104–124 Only 2 studies compared different frailty instruments head-to-head. 101,117 Seventy-six studies (84%) used a frailty index as their frailty instrument.…”

Section: Resultsmentioning

confidence: 99%

“…17,104–124 Only 2 studies compared different frailty instruments head-to-head. 101,117 Seventy-six studies (84%) used a frailty index as their frailty instrument. Of the instruments identified, 11 (50%) were developed de novo, and 4 (18%) were modified from preexisting instruments (Supplemental Digital Content, eTable 3, http://links.lww.com/AA/D544, for a summary of instruments used).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health Data

Alkadri¹,

Hage

Nickerson³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Frailty is a strong predictor of adverse outcomes in the perioperative period. Given the increasing availability of electronic medical data, we performed a systematic review and meta-analysis with primary objectives of describing available frailty instruments applied to electronic data and synthesizing their prognostic value. Our secondary objectives were to assess the construct validity of frailty instruments that have been applied to perioperative electronic data and the feasibility of electronic frailty assessment. METHODS: Following protocol registration, a peer-reviewed search strategy was applied to Medline, Excerpta Medica dataBASE (EMBASE), Cochrane databases, and the Comprehensive Index to Nursing and Allied Health literature from inception to December 31, 2019. All stages of the review were completed in duplicate. The primary outcome was mortality; secondary outcomes included nonhome discharge, health care costs, and length of stay. Effect estimates adjusted for baseline illness, sex, age, procedure, and urgency were of primary interest; unadjusted and adjusted estimates were pooled using random-effects models where appropriate or narratively synthesized. Risk of bias was assessed. RESULTS: Ninety studies were included; 83 contributed to the meta-analysis. Frailty was defined using 22 different instruments. In adjusted data, frailty identified from electronic data using any instrument was associated with a 3.57-fold increase in the odds of mortality (95% confidence interval [CI], 2.68–4.75), increased odds of institutional discharge (odds ratio [OR], 2.40; 95% CI, 1.99–2.89), and increased costs (ratio of means, 1.54; 95% CI, 1.46–1.63). Most instruments were not multidimensional, head-to-head comparisons were lacking, and no feasibility data were reported. CONCLUSIONS: Frailty status derived from electronic data provides prognostic value as it is associated with adverse outcomes, even after adjustment for typical risk factors. However, future research is required to evaluate multidimensional instruments and their head-to-head performance and to assess their feasibility and clinical impact.

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“…The study period was from 2006 to 2019. This national database is a multi-institutional registry that includes patient data from more than 600 participating hospitals [ 11 ]. This database is a risk-adjusted, outcome-based quality improvement program whose goal is for the improvement of surgical outcomes.…”

Section: Methodsmentioning

confidence: 99%

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

Sadur¹,

Quan²,

Nguyen³

et al. 2023

Cureus

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Purpose Metabolic syndrome is associated with postoperative morbidity and mortality in surgical patients. With the increased use of arthroscopic techniques for rotator cuff repair (RCR), it is important to identify the impact this disorder has on surgical patients. The purpose of this study is to evaluate the clinical impact of metabolic syndrome on outcomes following arthroscopic RCR. Methods The 2006-2019 National Surgical Quality Improvement Program database was queried for adult patients who underwent arthroscopic RCR. Two patient groups were categorized: patients with metabolic syndrome and patients without metabolic syndrome. Demographics, comorbidities, and 30-day postoperative outcomes were compared using bivariate and multivariate analyses. Results Of 40,156 patients undergoing arthroscopic RCR, 36,391 did not have metabolic syndrome and 3,765 had metabolic syndrome. After adjusting for differences in baseline characteristics between the two groups, those with metabolic syndrome had an increased risk of developing renal complications and cardiac complications, as well as requiring hospital admission postoperatively and hospital readmission. Conclusion Metabolic syndrome is an independent risk factor for developing renal and cardiac complications, as well as requiring overnight hospital admission and hospital readmission. Providers should understand the need for preoperative evaluation and surveillance of these patients following their surgery to minimize the risk of poor outcomes.

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Simplified preoperative tool predicting discharge destination after major oncologic gastrointestinal surgery

Cited by 8 publications

References 33 publications

Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward

Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward

A Systematic Review and Meta-Analysis of Preoperative Frailty Instruments Derived From Electronic Health Data

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

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