The Patient Safety in Surgery Study: Background, Study Design, and Patient Populations

Khuri, Shukri F.; Henderson, William G.; Daley, Jennifer; Jonasson, Olga; Jones, R. Scott; Campbell, Darrell A.; Fink, Aaron S.; Mentzer, Robert M.; Steeger, Janet E.

doi:10.1016/j.jamcollsurg.2007.03.028

Cited by 339 publications

(205 citation statements)

References 23 publications

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“…18 It is thought to result from anti-neutrophil antigen antibodies or anti-human leukocyte antigen antibodies. [18][19][20] Transfusion volume was associated with a risk-adjusted increase in the likelihood of minor complications, [6][7][8][9][10][11][12][13] units; patients who lived were given a median of 6 [5][6][7][8][9] red blood cell units including prolonged postoperative ventilation after cardiac surgery. 8 Although respiratory complications were the most frequent type of complication, we were unable to show a specific association between respiratory complications and increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy and reproducibility of these data are well established. 11,12 The ACS provides training for participating hospitals, ongoing education opportunities, and auditing to ensure data reliability. Preoperative through 30-day postoperative data are collected by a systematic sampling algorithm called the eight-day cycle and entered online in a Health Insurance Portability and Accountability Act (HIPAA)-compliant secure Web-based platform that can be accessed 24 hr a day.…”

Section: Methodsmentioning

confidence: 99%

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Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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Background Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality.Methods We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. Results The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (C 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma [ 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. Conclusion Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units. RésuméContexte Les transfusions massives sont associées à des taux élevés de morbidité et de mortalité; toutefois, les Presented in part at the Foundation for Anesthesia Education and Research session at the

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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“…A detailed description of the ACS-NSQIP database, including design, sampling strategy, and variable definitions, are available elsewhere. 10 This study was approved by the Cleveland Clinic Institutional Review Board. …”

Section: Data Sourcementioning

confidence: 99%

“…23 We cannot account for issues of surgeon and hospital volume, which are known to influence postoperative morbidity and mortality after craniotomy for brain tumor, 24 because it is ACS policy to maintain confidentiality for data-reporting institutions. 10 However, we did model for the presence or absence of resident participation in the OR, which is a surrogate for academic versus nonacademic hospitals and tends to correlate with hospital size and volume, and which was not identified as different between age groups (Table 1) nor related to any of our outcomes of interest (data not shown). In addition, the low levels of postoperative complications identified in our sample were similar to those at high-volume facilities.…”

Section: Limitationsmentioning

confidence: 99%

“…However, the sex and race distributions in the NSQIP database are representative of the US population, and data are collected prospectively from a substantial number of various types of institutions, thus providing a large and diverse sample size. 10 Additional benefits of the NSQIP database are that data are collected in a standardized manner at each site with strict variable definitions and annual quality checks 10 and the database has been validated for accuracy and reproducibility and achieves a >95% 30-day outcome follow-up rate across consecutive cycles. 10,26 In conclusion, to our knowledge, this is the first prospective, multi-institutional study to assess the relation between age, other preoperative and perioperative risk factors, and short-term outcomes after craniotomy for definitive tumor resection in the elderly (aged !75 years) compared with younger adults.…”

Section: Limitationsmentioning

confidence: 99%

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Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

Seicean

Schiltz

et al. 2012

Cancer

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BACKGROUND. Disparity in resection rates for malignant brain tumors in elderly patients is partially attributed to a belief that advanced age is associated with an increased risk of postoperative morbidity and mortality. The objective of this study was to investigate the effect of advanced age (!75 years) on 30-day outcomes in patients with primary and metastatic brain tumors who underwent craniotomy for definitive resection of a malignant brain tumor. METHODS. The authors conducted prospective analyses of the American College of Surgeons' National Surgical Quality-Improvement Project (NSQIP) database from 2006 to 2010 of 970 patients aged !40 years who underwent craniotomy for definitive resection of neoplasm. Preoperative and intraoperative characteristics and 30-day outcomes were stratified by age. By using propensity scores, 134 patients (aged !75 years) were matched to 134 patients ages 40 to 74 years. Logistic regression was used to predict adverse postoperative outcomes. RESULTS. The median length of hospital stay was 5 days; the rate of minor and major complications were 5.9% and 13.1%, respectively; 5.7% of patients returned to the operating room; and 4.3% of patients died within 30 days. Advanced age did not increase the odds for poorer short-term outcomes. CONCLUSIONS. Advanced age did not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors when analyses were controlled for other risk factors. These results suggest that age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy.

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Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis

Gajdos¹,

Hawn²,

Kile³

et al. 2013

JAMA Surg

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The Patient Safety in Surgery Study: Background, Study Design, and Patient Populations

Cited by 339 publications

References 23 publications

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Short‐term outcomes of craniotomy for malignant brain tumors in the elderly

Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis

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