American College Of Surgeons NSQIP Research Articles

Perioperative outcomes and trends of transurethral surgeries for benign prostatic hyperplasia in octogenarians: a comprehensive analysis using the NSQIP database (2011-2022).

Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13-71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%.

Influence of Perioperative COVID-19 Infection on Surgical Outcomes and Risk Adjustment for Quality Assessment in the American College of Surgeons NSQIP.

Surgical patients with perioperative COVID-19 infection experience higher rates of adverse events than those without COVID, which may lead to imprecision in hospital-level quality assessment. Our objectives were to quantify differences in COVID-19 associated adverse events in a large national sample and examine distortions in surgical quality benchmarking if COVID status is not considered. Data included 793,280 patient records from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from April 1, 2020 to March 31, 2021. Models predicting 30-day Mortality, Morbidity, Pneumonia, Ventilator Dependency > 48 hours, and unplanned intubation were constructed. Risk adjustment variables were selected for these models from standard NSQIP predictors and perioperative COVID status. 5,878 (0.66%) had preoperative COVID and 5,215 (0.58%) had postoperative COVID. COVID rates demonstrated some consistency across hospitals (median preoperative 0.84%, IQR=0.14%-0.84%; median postoperative 0.50%, IQR=0.24%-0.78%). Postoperative COVID was always associated with increased adverse events. For postoperative COVID among all cases, there was nearly a six-fold increase in Mortality (1.07% to 6.37%) and15-fold increase in Pneumonia (0.92% to 13.57%), excluding the diagnosis of COVID itself. The effects of preoperative COVID were less consistent. Inclusion of COVID in risk-adjustment models had minimal effects on surgical quality assessments. Perioperative COVID was associated with a dramatic increase in adverse events. However, quality benchmarking minimally affected. This may be the result of low overall COVID rates or balance in rates established across hospitals over the 1-year observational period. There remains limited evidence for restructuring ACS NSQIP risk-adjustment for the time-limited effects of the COVID pandemic.

Number of Hepatic Resections and Association with Complication after Metastatic Neuroendocrine Tumor Debulking: An American College of Surgeons NSQIP Database Study.

Neuroendocrine tumor liver metastases (NELM) are a major source of morbidity and mortality in neuroendocrine tumor patients and can be treated with hepatic debulking surgery (HDS). This study aims to identify variables associated with postoperative morbidity in NELM HDS. This analysis uses the American College of Surgeons NSQIP targeted hepatectomy-specific Participant User File from 2014 to 2020. Surgeries were grouped by number of hepatic resections performed (1 to 5, 6 to 10, greater than 10). Multivariable logistic regression and matching were used to identify prognostic factors of morbidity. A total of 1,163 patients were included. A total of 1,011 (87%) had 1 to 5 hepatic resections, 101 (8.7%) had 6 to 10 resections, and 51 (4.4%) had greater than 10 resections. The overall complication rate was 35%, and surgical and medical complications reached 30% and 13%, respectively. Mortality occurred in 11 patients (0.9%). Significantly higher rates of any (34% vs 35% vs 53%, p = 0.021) and surgical complications (29% vs 28% vs 49%, p = 0.007) were noted for those undergoing greater than 10 resections (1 to 5 resections, 6 to 10, greater than 10). "Bleeding requiring transfusion" (p < 0.0001) occurred more frequently in the greater than 10 resection group. On multivariable logistic regression, greater than 10 resections were an independent risk factor for any (odds ratio [OR] 2.53, p = 0.002; OR 2.52, p =. 0013) and surgical (OR 2.53, p = 0.003; OR 2.88, p = 0.005) complications compared with 1 to 5 resections and 6 to 10 resections, respectively. Medical complications (OR 2.34, p = 0.020) and length of stay greater than 5 days (OR 1.98, p = 0.032) were also increased with greater than 10 vs 1 to 5 resections. As reported by NSQIP, NELM HDS were performed safely with low mortality. However, more hepatic resections, especially greater than 10, were associated with increased postoperative morbidity and length of stay.

Quantifying the Prognostic Value of Preoperative Surgeon Intuition: Comparing Surgeon Intuition and Clinical Risk Prediction as Derived from the American College of Surgeons NSQIP Risk Calculator.

Surgical risk prediction models traditionally use patient attributes and measures of physiology to generate predictions about postoperative outcomes. However, the surgeon's assessment of the patient may be a valuable predictor, given the surgeon's ability to detect and incorporate factors that existing models cannot capture. We compare the predictive utility of surgeon intuition and a risk calculator derived from the American College of Surgeons (ACS) NSQIP. From January 10, 2021 to January 9, 2022, surgeons were surveyed immediately before performing surgery to assess their perception of a patient's risk of developing any postoperative complication. Clinical data were abstracted from ACS NSQIP. Both sources of data were independently used to build models to predict the likelihood of a patient experiencing any 30-day postoperative complication as defined by ACS NSQIP. Preoperative surgeon assessment was obtained for 216 patients. NSQIP data were available for 9,182 patients who underwent general surgery (January 1, 2017 to January 9, 2022). A binomial regression model trained on clinical data alone had an area under the receiver operating characteristic curve (AUC) of 0.83 (95% CI 0.80 to 0.85) in predicting any complication. A model trained on only preoperative surgeon intuition had an AUC of 0.70 (95% CI 0.63 to 0.78). A model trained on surgeon intuition and a subset of clinical predictors had an AUC of 0.83 (95% CI 0.77 to 0.89). Preoperative surgeon intuition alone is an independent predictor of patient outcomes; however, a risk calculator derived from ACS NSQIP is a more robust predictor of postoperative complication. Combining intuition and clinical data did not strengthen prediction.

Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database.

The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS NSQIP database, this study examined the methodologic reporting of HPB publications. Web of Science core collection (all editions) was queried for all HPB studies using the ACS NSQIP database published between 2004 and 2022. In addition, a critical appraisal was performed using the JAMA Surgery checklist, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. In total, 276 studies were included in the analysis. The median scores for the JAMA Surgery checklist, RECORD statement, and STROBE statement were 4 of 7 (interquartile range [IQR] 3 to 5), 3 of 10 (IQR 2 to 4), and 15 of 21 (IQR 13 to 17), respectively. The criteria with the highest rates of nonadherence were discussing competing risks, clear definitions of inclusion and exclusion criteria, unadjusted and adjusted outcomes, provision of supplementary data, and performing subgroup analyses. Additionally, when examining checklist fulfillment of hepatobiliary studies and pancreatic studies separately, pancreatic studies demonstrated significantly greater fulfillment of the STROBE statement checklist items. Satisfactory reporting of methodology is present among HPB studies utilizing the ACS NSQIP database, with multiple opportunities for improvement. Areas for improved adherence include discussing competing risks, providing supplementary information, and performing appropriate subgroup analysis. Given the increasing role of large-scale databases in surgical research, enhanced commitment to reporting guidelines may advance HPB research and ensure quality reporting.

Robotic-Assisted Minimally Invasive Pancreaticoduodenectomy: Is Laparoscopy Still Justified? A Study on National Trends and Outcomes from the American College of Surgeons NSQIP

Robotic-Assisted Minimally Invasive Pancreaticoduodenectomy: Is Laparoscopy Still Justified? A Study on National Trends and Outcomes from the American College of Surgeons NSQIP

Current Trends in Pancreatoduodenectomy: A NSQIP Study

Introduction: Pancreaticoduodenectomy (PD) remains one of the most challenging and complex surgical procedures, with high morbidity rates, prolonged hospital length of stay (LOS), and high resource use. With continued evolution in treatment and peri-operative care plans, this study aimed to evaluate trends in preoperative and operative factors and postoperative surgical outcomes after PD over a 7-year period (2014-2020). Methods: The American College of Surgeons NSQIP pancreas-targeted database was queried to identify patients with pancreatic malignancy who underwent PD from 2014 to 2020. Trends in patient demographics, operative factors, and postoperative outcomes were computed and analyzed using the Jonckheere-Terpstra trend test. Results: A total of 13,933 pancreatic cancer patients who underwent PD were included. From 2014 to 2020, patients older than 65 years increased from 56.0% to 60.6%, non-White patients increased by 2.54% (mainly in Asian patients), and the rate of neoadjuvant chemotherapy increased by 26.6%(p < 0.001). Significant trends in operative factors include an increase in minimally invasive surgery (MIS) approach from 6.4% to 9.4% (p < 0.001) and vascular resection from 22.1% to 26.3% (p < 0.001). Postoperative early discharge (<5 days) increased from 10.4% to 24.0% (p < 0.001), while the rates of pancreatic fistula and complication of any type decreased from 12.7% to 6.9% and 40.9% to 35.7% respectively (p < 0.001). Conclusion: Over this recent 7-year period evaluated time, significant changes have occurred in demographics, operative factors, and outcomes of patients undergoing PD for pancreatic cancer. Understanding the evolving nature of PD conduct and outcome is relevant to comprehending this population’s needs, characteristics, and perioperative planning.

Determining Hospital Cost for Postoperative Complications: A Strategy to Drive Investment into Your Colorectal Surgery Quality Improvement Program

INTRODUCTION: Postoperative complication (POC) significantly increase healthcare cost. Identifying sources of cost variation helps implement or justify quality improvement programs. This study focuses on the incidence and POC cost after colorectal surgery (CRS). METHODS: Institutional data using the American College of Surgeons NSQIP was queried from 2013 to 2019 for patients undergoing CRS and merged with our financial database. Incidence of NSQIP-defined POC was determined in addition to index hospitalization (IHC) and 30-day post-discharge direct cost (PDCC). PDCC includes labs, imaging, clinic visits, readmission, and emergency department visits to our institution. RESULTS: A total of 2233 patients were identified, with 23.9% experiencing a POC resulting in a 1.5-4.5-fold increase in IHC and 2-15-fold increase in PDCC compared with patients who experienced no POCs. Each complication led to a significant increase in IHC/PDCC cost (p < 0.001). Most of these patients experienced one POC (N = 307, 13.7%) but the remaining experienced 2-6 POCs (N = 227, 10.1%). Anastomotic leak occurred in 5.5% (N = 123) of cases and were categorized by treatment: reoperation (N = 63), nonoperative intervention, ie percutaneous or endoscopic (N = 35), or no intervention (N = 25). All treated leaks resulted in additional significant IHC/PDCC (p <0.001). Overall rate of readmission was 10.5% and unplanned reoperation was 8.0% (Table). CONCLUSION: POC after CRS is common and adds a significant healthcare, cost both during the index hospitalization and post-discharge. This underscores the importance of and should justify investment in enhanced recovery programs, surgical site infection prevention bundles, and prehabilitation programs, which can mitigate the occurrence of many of the POCs considered. Table. - NSQIP Complication and Cost after Colorectal Surgery Characteristic N Incidence Mean index of hospitalization cost Mean 30-day post-discharge cost All Patients 2233 $27,123 ± 31,428 $3,127 ± 13,752 No Postoperative Complication 1699 76.1% $19,424 ± 12,158 $1,352 ± 5,503 Post Operative Complication(s) 534 23.9% $51,620 ± 53,621 $8,774 ± 25,563 Deep SSI 51 2.3% $49,885 ± 50,417 $21,747 ± 43,915 Organ/Space SSI 125 5.6% $54,832 ± 54,065 $13,448 ± 21,045 Sepsis 103 4.6% $40,455 ± 34,456 $7,286 ± 12,608 Respiratory Failure 184 8.2% $85,807 ± 64,197 $10,142 ± 34,231 Prolonged NPO/NGT Use aka “ileus” 494 22.1% $48,153 ± 49,561 $7,701 ± 26,274 Anastomotic Leak treated with Reoperation 63 2.8% $83,344 ± 82,075 $20,340 ± 33,018

Committed to Better Outcomes: Reducing Infection after Surgery Across the Ontario Surgical Quality Improvement Network

In 2015, the Ontario Surgical Quality Improvement Network was established to create a community of practice for Ontario hospitals to improve surgical quality. A provincial campaign to decrease postsurgical infections was launched in2017. Thirty hospitals implemented activities related to the campaign from April 2018 to March 2019. The community of practice was used to disseminate suggested change ideas in each area. Self-reported data from participating hospitals and collaborative-wide aggregate risk-adjusted data from the American College of Surgeons NSQIP were reviewed to determine the impact of the campaign on the rates of postoperative surgical site infections (SSIs), urinary tract infections (UTIs), and pneumonia. A total of 24, 8, and 2 hospitals selected SSIs, UTIs, and pneumonia, respectively, as their targets for improvement. Three hospitals selected both SSIs and UTIs, 1 hospital selected SSIs and pneumonia, and 1 hospital selected all 3 indicators as targets. Self-reported data demonstrated that the rates of SSIs and UTIs decreased significantly post campaign from 4.87% to 3.99% (p < 0.0001) and from 3.65% to 1.25% (p= 0.007), respectively. Pneumonia rates also decreased from 1.27% to 1.05%. Overall rates of SSIs, UTIs, and pneumonia across all Ontario Surgical Quality Improvement Network hospitals were reduced from 3.4%, 1.29%, and 0.88% to 3.37%, 1.14%, and 0.84%, respectively. The 1-year campaign resulted in a clinically significant reduction in the rates of SSIs and UTIs, as well as a trend for decrease in pneumonia incidence among participating hospitals. Using a flexible approach with priority setting and leveraging the community of practice for dissemination of change ideas is an effective way of sustaining quality improvement activities.

Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team

Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.

Thirty-Day Morbidity after Simultaneous Resection of Colorectal Cancer and Colorectal Liver Metastasis: American College of Surgeons NSQIP Analysis

Approximately 20% of patients with colorectal cancer (CRC) present with synchronous liver metastases (CRLM). The decision to resect simultaneously or sequentially remains controversial. The primary aim of this study was to determine whether simultaneous resection of CRC and CRLM is associated with increased complications compared to isolated resection. Prospective data from the American College of Surgeons (ACS) NSQIP, including the ACS NSQIP procedure-specific colectomy and hepatectomy modules from 2014 to 2017, were reviewed in a retrospective cohort study. Primary study outcome was combined 30-day complication rates; secondary outcomes included colectomy and hepatectomy-specific complication. Multivariable logistic regression was performed to control for confounding factors associated with postoperative complication. A total of 23,643 patients underwent colectomy, 7,462 hepatectomy, and 592 simultaneous resection for CRC and CLRM. Overall morbidity was higher among patients treated with simultaneous resection (29.9%) compared with either isolated colorectal (22.2%) or hepatic resection (17.1%; p < 0.001). Additionally, postoperative ileus (36.4% vs 19.1%) and anastomotic failure (7.9% vs 3.8%) were more common after simultaneous resection compared with colorectal resection (p < 0.05). Similarly, rates of bile leak (8.3% vs 6.2%, p=0.195) and post-hepatectomy liver failure (8.7% vs 3.8%, p < 0.001) were higher after simultaneous resection compared with isolated hepatectomy. By multivariable logistic regression, simultaneous resection was associated with increased overall complication compared with isolated colon (odds ratio 1.64 [95% CI 1.36 to 1.96]) or liver resection (odds ratio 2.11 [95% CI 1.75 to 2.55]), as well as increased procedure-specific complication. Although simultaneous resection offers definitive resection for patients with synchronous CRC and CRLM, it is associated with significantly increased 30-day overall and procedure-specific postoperative morbidity.

Current trends and 30-day surgical outcomes for thyroglossal duct cyst excision in children

ObjectiveIdentify current trends, adverse events, and clinical predictors in children treated with thyroglossal duct cyst surgery. MethodsCross-sectional analysis using American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012–2016. Patients were identified using CPT codes: 60280 - excision of thyroglossal duct cyst or sinus and 60281 - excision of thyroglossal duct cyst or sinus, recurrent. Results1532 (333 inpatient and 1199 outpatient) total cases were identified. Median age was 5.16 years interquartile range [IQR] (2.87, 8.35 years). No mortalities, cases of sepsis or nerve injury were identified. Adverse event rate was 4.4% (68/1532). Inpatient cases were associated with higher rates of adverse events (p = 0.006). Adverse events mostly consistent of wound infections, unplanned reoperations and readmissions, 2.6%, 2.2% and 2.0%, respectively. The most common unplanned reoperation was hematoma, seroma, or fluid drainage (0.59%). Median length of stay was 1 day, IQR (0, 1). An adjusted, multivariable logistic regression model revealed that the odds of adverse event rates for inpatient status were 101% higher than outpatients (odd ratio [OR] = 2.01; 95% CI = 1.20, 3.37; p = 0.008). ConclusionsThe most common adverse events were unplanned reoperations and readmissions. Outpatient surgery was most common and surgery for recurrent thyroglossal duct cysts was rare. Children selected for outpatient thyroglossal duct cyst surgery tended to be healthier and less medically complicated and may contribute to our observation of lower rates of adverse events compared to inpatients.

International Normalized Ratio (INR) is Comparable to MELD in Predicting Mortality after Cholecystectomy

Guidelines suggest targeting a preoperative international normalized ratio (INR) < 1.5. We examined and compared the predictive value of INR relative to the Model for End-Stage Liver Disease (MELD). We reviewed the American College of Surgeons NSQIP from 2005 to 2016 for adult patients undergoing open or laparoscopic cholecystectomy. Patients with a preoperative INR were stratified into groups: ≤1, >1 to ≤1.5, >1.5 to ≤2, and >2. Thirty day postoperative mortality was the primary outcome. Multivariable logistic regressions controlled for baseline differences. Of 58,177 cholecystectomy patients, 15.2 per cent had INR ≤ 1, 80.4 per cent had INR > 1 to ≤1.5, 3.7 per cent had INR > 1.5 to ≤2, and 0.7 per cent had INR > 2. Patients with INR > 2 were older and more likely to have diabetes and hypertension (P < 0.001). Multivariable regression demonstrated a stepwise increase in mortality for INR > 1 to ≤1.5 (odds ratio (OR) = 1.50 [1.10-2.05]), INR > 1.5 to ≤2 (OR = 2.96 [1.97-4.45]), and INR > 2 (OR = 3.21 [1.64-6.31]) relative to INR ≤ 1. C-statistic for INR (0.910) and MELD (0.906) models indicated a similar value in predicting mortality. INR groups also faced an incremental, increased risk of bleeding. Although unable to track preoperative correction of INR, this analysis identifies that INR remains an excellent predictor of postoperative mortality and bleeding after both open and laparoscopic cholecystectomies and is comparable to MELD.

Impact of Neoadjuvant Chemotherapy on the Postoperative Outcomes of Patients Undergoing Liver Resection for Colorectal Liver Metastases: A Population-Based Propensity-Matched Analysis

The role of neoadjuvant chemotherapy in the management of colorectal liver metastases remains controversial. We sought to investigate whether neoadjuvant systemic chemotherapy contributes to clinically significant increases in postoperative morbidity and mortality using a population-based cohort. The American College of Surgeons NSQIP Targeted Hepatectomy Participant Use Files were queried from 2014 to 2016 to identify patients with colorectal liver metastases who underwent liver resection. Patients were stratified by receipt of neoadjuvant chemotherapy using propensity score matching. Univariate and multivariable analyses were used to characterize the effect of neoadjuvant chemotherapy on perioperative morbidity and mortality. After propensity score matching, 1,416 (50%) patients received neoadjuvant chemotherapy before hepatectomy and 1,416 (50%) underwent liver resection without neoadjuvant chemotherapy. There were no differences in age (60 vs 61 years), maximum tumor size (≤5 cm: 79% vs 80%, >5 cm: 21% vs 20%), resection type (partial hepatectomy: 69% vs 70%), simultaneous colectomy (9% vs 9%), or use of preoperative portal vein embolization (5% vs 5%) in those undergoing neoadjuvant chemotherapy compared with those who did not (all, p > 0.05). Overall 30-day postoperative morbidity (34% vs 33%), including rates of biliary fistula (6% vs 5%), post-hepatectomy liver failure (5% vs 5%), and mortality rates (0.8% vs 0.7%), were similar among patients who received neoadjuvant chemotherapy vs those who did not (all, p > 0.05). On multivariable analysis, receipt of neoadjuvant chemotherapy was not associated with increased morbidity (odds ratio 1.07; 95% CI 0.90 to 1.27; p= 0.43) or mortality (odds ratio 1.09; 95% CI 0.44 to 2.72; p= 0.85). In this propensity-matched population-based cohort study, the use of neoadjuvant systemic chemotherapy was not associated with higher rates of complications, biliary fistula, post-hepatectomy liver failure, or mortality among patients with colorectal liver metastases undergoing liver resection.

Outcomes of surgical treatment for hemangiomas.

To quantify complications and rates of adverse events associated with surgical excision of hemangiomas in children using a national surgical database. Pediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® -pediatric), years 2012-2016. Subjects included children under 18years with a postoperative diagnosis of International Classification of Diseases (ICD), 9th revision code: 228.00 and 228.01, or ICD 10 codes D18.00 and D18.01-hemangioma, any site and hemangioma, of skin and subcutaneous tissue. A total of 1180 patients were included. The median age was 3.2years (interquartile range [IQR] 1.2 to 6.4years old). No occurrences of deep incisional surgical site infection, nerve injury, mortality, sepsis, septic shock, or blood stream infections were noted. In multivariate analysis, age ≤ 3years and advanced American Society of Anesthesiologists class were significant predictors of adverse events (P=0.035 and 0.001, respectively). For children with infantile hemangioma who fail to respond or have an incomplete response to medical therapy, surgical resection may be a relatively safe treatment alternative. Children older than 3years of age with hemangiomas had less surgical adverse events than younger children. Overall, however, the surgical complications rates were low and deemed relatively minor.

30-Day outcomes analysis of NSQIP-pediatric for surgical management of head and neck lymphatic malformations in children

ObjectiveIdentify adverse events associated with surgical management of head and neck lymphatic malformations in children by investigating a US national database. Data sourcePediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program® (ACS NSQIP® - pediatric), years 2012–2016. MethodsSubjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9 th revision code: 228.1 – lymphangioma, any site or ICD-10 code D18.1. Results163 patients were identified. 67 (41.1%) were female and 96 (58.9%) were male. The median age was 4.2 years (interquartile range [IQR] 1.6–11.3 years). Sixty-five (39.9%) underwent head and neck procedures. 19 (11.7%) patients with 30-day adverse events were identified, with unplanned reoperation being the most common; in the head and neck surgery group, there were 5 (7.7%). There was no significant difference in the occurrence of adverse events between head and neck surgery and the non-head and neck surgery group (p = 0.2238). ConclusionsNo individual patient clinical factors were identified to be associated with increased rates of 30-day adverse event rates for surgical management of lymphatic malformations in children. Our investigation highlights the need for quality improvement to help decrease 30-day adverse events for surgery for this group, as the rate was quite high overall (11.7%). The wound complication rate was very low, but we observed a non-negligible number of reoperations and readmissions. Improving quality of care for surgical management of lymphatic malformations in children should focus future investigations on limiting reoperations and readmissions within the first 30 days postoperatively.

Respiratory Complications in Low, Intermediate, and High-Risk Operations: A Trend Analysis from 2007 to 2016 Using American College of Surgeons NSQIP

Stokes, Sean M. MD; Brooke, Benjamin S. MD, PhD, FACS; Glasgow, Robert E. MD, FACS; Finlayson, Samuel MD, MPH; Varghese, Thomas K. MD, MS Author Information

Contemporary Thyroidectomy Practice Patterns among General Surgery and Otolaryngology: Analysis of the 2016 American College of Surgeons NSQIP

Contemporary Thyroidectomy Practice Patterns among General Surgery and Otolaryngology: Analysis of the 2016 American College of Surgeons NSQIP

Overall Complications with Preoperative Biliary Stenting vs Pancreaticoduodenectomy in Patients with Pancreatic Adenocarcinoma and Obstructive Jaundice: Analysis of the American College of Surgeons NSQIP

Overall Complications with Preoperative Biliary Stenting vs Pancreaticoduodenectomy in Patients with Pancreatic Adenocarcinoma and Obstructive Jaundice: Analysis of the American College of Surgeons NSQIP

Sustained Positive Impact of American College of Surgeons NSQIP on Outcomes after Colorectal Surgery During the Last Decade

Al-Mazrou, Ahmed M. MD, MB, BS; Zhang, Haiqing MD; Yu, Guanying MD; Kiran, Pokala MB, BS, MS, FRCS, FACS, FASCRS Author Information