Wound Complications after Inguinal Lymph Node Dissection for Melanoma: Is ACS NSQIP Adequate?

Glarner, Carly E.; Greenblatt, David Yü; Rettammel, Robert J.; Neuman, Heather B.; Weber, Sharon M.

doi:10.1245/s10434-012-2856-7

Cited by 34 publications

(22 citation statements)

References 11 publications

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“…Glarner, et al reported that wound complications rates after inguinal lymph node dissection for melanoma are much lower according to ACS NSQIP compared to single institution data because the ACS NSQIP definition of wound occurrences does not include seroma, hematoma, lymph leak or skin necrosis (15). Similarly, Eck and colleagues demonstrated that ACS NSQIP reports higher morbidity rates after breast conserving surgery compared to mastectomy because it includes reoperation for positive margins as a complication (16).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

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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“…Some of the common factors associated with surgical complications such as smoking, recent weight loss, and serum albumin concentrations [22] were not recorded. Nonetheless, in general, the subjects were relatively healthy therefore recent weight changes or abnormalities in albumin were unlikely.…”

Section: Discussionmentioning

confidence: 99%

Safety of Excisional Inguinal Lymph Node Biopsies Performed for Research Purposes in HIV-1-Infected Women and Men

Meditz

Connick²,

McCarter³

2014

Surgical Infections

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Background: Most HIV-1 replication occurs in secondary lymphoid tissues, and evaluating these tissues is crucial to investigations of pathogenesis. Inguinal lymph nodes (LN) are obtained frequently for these studies as they are readily detectable in most individuals and provide abundant numbers of cells. Knowledge of the outcomes of inguinal LN excision for research purposes is important to inform accurately study participants and researchers of the potential risks. Methods: Data on surgical complications were collected in real time in HIV-1-infected subjects who underwent excisional inguinal LN biopsies for research purposes from February 1997 through June 2011. Data were analyzed retrospectively to determine the frequency of surgical complications using the Fisher exact test and nonparametric testing. Results: Eighty-seven research subjects underwent a total of 95 LN excisions. Thirty-six percent of subjects were female, 53% were white, 26% were black, 16% Hispanic, and 2% Native American. Median age was 36 y (22-52). The median CD4 + T cell count was 478 cell/mm 3 (range, 57-1117) and the median plasma HIV-1 RNA concentration was 4.1 log 10 copies/mL (range, 1.7-5.9). Minor complications including seroma, transient lymphedema, hematoma, and allergic reaction to surgical tape, occurred in 10% of procedures. Complications that required medical attention occurred in an additional 10% of procedures, and included cellulitis (5%), superficial incisional surgical site infection (3%), and seroma requiring aspiration (1%). Subjects with complications had a lower BMI (25; range, 16-38; n = 12) than others (28; range, 19-57; n = 40; p = 0.05) and tended to have higher platelets, (median, 259 · 10

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“…The limitations of NSQIP in capturing clinically relevant postoperative complications have also been noted for melanoma, thyroid, and pancreatic surgery. [6][7][8] In another study of patients undergoing breast reconstruction or breast reduction, Khavanin and colleagues compared NSQIP to the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. 9 The authors found that compared to TOPS, NSQIP missed surgical complications and was not able to define the complications as specifically as TOPS.…”

mentioning

confidence: 99%

Bilateral Mastectomy: Doubling Down on Complications?

Tuttle

Burke

2015

Ann Surg Oncol

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Complications after breast cancer surgery can result in increased hospitalization, additional surgical and medical interventions, increased costs, and delays in initiating recommended adjuvant treatment. Moreover, complications may lead to long-term emotional distress and patient dissatisfaction. Thus, accurate information regarding the risk, severity, and timing of postoperative complications must be clearly presented to breast cancer patients. In the accompanying study by Silva and colleagues, the authors used the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) to compare the rates of postoperative complications between unilateral and bilateral mastectomy among patients who underwent immediate reconstruction. 1 The authors reported that bilateral mastectomy was associated with longer hospital stays and higher transfusion rates than unilateral mastectomy. Also, bilateral mastectomy with implant reconstruction was associated with a modestly increased reoperation rate. Surprisingly, surgical site infections, prosthesis failure, and medical complications occurred at similar rates between unilateral and bilateral mastectomy. For implant-reconstructed patients, the overall complication rate was 8.8 % after unilateral mastectomy and 10.1 % after bilateral mastectomy. The rates of surgical site complications were 4.2 and 4.6 %, respectively.Determining the rates of postoperative complications after breast cancer surgery can be a frustrating endeavor. Published studies vary widely in regards to the definition, inclusion, and severity of postoperative complications. In addition, the length of follow-up from different studies ranges from a few weeks to a few years. As a result, the published rates of postoperative complications after breast surgery vary dramatically from study to study. Even the results from different studies using the same database seem incongruent. For example, Silva and colleagues report the 30-day surgical site complication rate after bilateral mastectomy and implant-based reconstruction as only 4.6 %. In a very similar study also using NSQIP, Osman and colleagues report the 30-day surgical site complication rate after bilateral mastectomy without reconstruction as 5.8 %.2 Is the surgical site complication rate really lower for mastectomy after implant-based reconstruction as compared with mastectomy without reconstruction? Also, in the report by Osman and colleagues, the risk of postoperative complications was almost double after bilateral mastectomy as compared to unilateral mastectomy.The 30-day outcomes reported by Silva and colleagues likely substantially underestimate the overall postoperative complication rates after bilateral mastectomy and reconstruction. In a multicenter study from the Cancer Research Network, Barton and colleagues determined the complication rates after bilateral mastectomy. 3 In their patient cohort, 69.1 % underwent implant reconstruction, and almost two-thirds of the women undergoing bilateral mastectomy had at least one complication.3 ...

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Wound Complications after Inguinal Lymph Node Dissection for Melanoma: Is ACS NSQIP Adequate?

Cited by 34 publications

References 11 publications

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

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

Safety of Excisional Inguinal Lymph Node Biopsies Performed for Research Purposes in HIV-1-Infected Women and Men

Bilateral Mastectomy: Doubling Down on Complications?

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