National Surgical Quality Improvement Database Research Articles

Preoperative chronic steroid use as a risk factor for complications following open reduction internal fixation for proximal humerus fracture.

The primary objective of this study was to investigate the association between preoperative chronic steroid use and postoperative complications following open reduction internal fixation(ORIF) for proximal humerus fractures(PHF). The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for all patients who underwent PHF ORIF between 2015 and 2021. A total of 6,273 patients were included in this study, of which 3.4% (n = 212) were in the chronic steroid use cohort. Patient characteristics including demographics, comorbidities, and 30-day postoperative complications after PHF ORIF were collected. Bivariate logistic regression and multivariate logistic regression analysis, adjusted for all significantly associated variables, was conducted to investigate the relationship between preoperative chronic steroid use and postoperative complications. Chronic steroid use was significantly associated with age ≥ 75 (p < 0.001), male gender (p =0.006), dependent functional status (p = 0.008), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), CHF (p = 0.007), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorder (p = 0.007), ascites (p = 0.040), disseminated cancer (p< 0.001), and systemic sepsis (p < 0.001). After adjusting for all significantly associated variables, chronic steroid use was independently associated with major complication (OR 1.60, 95% CI 1.06-2.43; p = 0.026), and non-home discharge (OR 1.05, 95% CI 1.01-1.08; p = 0.014). Preoperative chronic steroid use is associated with increasing rate of postoperative complications following PHF ORIF. Better understanding and characterizing chronic steroid use as a preoperative risk factor can aid physicians in risk stratification to reduce rates of postoperative complications following PHF ORIF. III. Retrospective Cohort Comparison; Prognosis Study.

Postoperative complications associated with congestive heart failure inaseptic revision total shoulder arthroplasty.

The aim of this study is to explore potential complications and risk factors associated with revision TSA in patients with congestive heart failure (CHF). This study examined all individuals who underwent revision total shoulder arthroplasty (TSA) from 2015 to 2022, sourced from the American College of Surgeons National Surgical Quality Improvement database. The analysis encompassed patient demographics, comorbidities, and 30-day postoperative complications. Logistic regression was employed to analyze the postoperative complications linked to patients with preoperative CHF. Compared to patients without CHF, patients with CHF were significantly associated with dependent functional status (P < .001), chronic obstructive pulmonary disease (P < .001), and hypertension (P = .002). Compared to patients without CHF, patients with CHF were independently associated with a significantly greater likelihood of experiencing any complication (OR 2.19, 95%CI 1.12-4.29; P = .022) and non-home discharge (OR 3.02, 95%CI 1.37-6.65; P = .006). Congestive heart failure was identified as an independent risk factor for experiencing any complication and non-home discharge in patients undergoing revision TSA. Awareness of the cardiovascular health status of a patient and its severity can influence the decision-making process when considering revision TSA. Retrospective Cohort Comparison Using Large Database; Prognosis Study.

Preoperative risk factors for anastomotic leak after esophagectomy with gastric reconstruction: A 6-year national surgical quality improvement (NSQIP) database analysis

BackgroundAnastomotic leak is a serious complication after esophagectomy that has been associated with worse outcomes. However, identifying patients at increased risk for anastomotic leak remains challenging. MethodsPatients were included from the 2016 to 2021 National Surgical Quality Improvement Project database who underwent elective esophagectomy with gastric reconstruction for cancer. A multivariable logistic regression model was used to identify risk factors associated with anastomotic leak. ResultsA total of 4,331 patients were included in the study, of whom 647 patients experienced anastomotic leak (14.9%). Multivariable logistic regression revealed higher odds of anastomotic leak with smoking (adjusted odds ratio 1.24, confidence interval 1.02–1.51, P = .031), modified frailty index-5 score of 1 (adjusted odds ratio 1.44, confidence interval 1.19–1.75, P = .002) or 2 (adjusted odds ratio 1.52, confidence interval 1.19-1.94, P = .000), and a McKeown esophagectomy (adjusted odds ratio 1.44, confidence interval 1.16–1.80, P = .001). Each 1,000/μL increase in white blood cell count was associated with a 7% increase in odds of anastomotic leak (adjusted odds ratio 1.07, confidence interval 1.03–1.10, P = .0005). Higher platelet counts were slightly protective, and each 10,000/ μL increase in platelet count was associated with 2% reduced odds of anastomotic leak (adjusted odds ratio 0.98, confidence interval 0.97–0.99, P = .001). ConclusionIn this study, smoking status, frailty index, white blood cell count, McKeown esophagectomy, and platelet counts were all associated with the occurrence of anastomotic leak. These results can help to inform surgeons and patients of the true risk of developing anastomotic leak and potentially improve outcomes by providing evidence to improve preoperative characteristics, such as frailty.

Smoking impacts outcomes in transcervical Zenker's diverticulectomy

PurposeThere is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker's diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker's diverticulectomy based on patient smoking status. Methods and materialsThis paper is a retrospective cohort review. The 2005–2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker's diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status. ResultsOf the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030). ConclusionIn a cohort of patients undergoing transcervical Zenker's diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.

5-Factor Modified Frailty Index as a Predictor of Outcomes After Hemiarthroplasty or Total Hip Arthroplasty for Femoral Neck Fracture.

Although the 5-factor modified frailty index (mFI-5) has been shown to be an independent predictor of complications after primary total hip arthroplasty (THA), its predictive value has not been evaluated in the setting of hip fracture. We therefore assessed the utility of mFI-5 score as an independent predictor of morbidity and mortality in patients who underwent THA or hemiarthroplasty for femoral neck fracture. The American College of Surgeons National Surgical Quality Improvement database was queried for all patients with femoral neck fractures treated with THA or hemiarthroplasty between 2006 and 2020. A multivariate logistic regression analysis was done using mFI-5 as a predictor while controlling for baseline demographic and clinical variables. In total, 45,185 patients (hemiarthroplasty: 37,645; THA: 7,540) were identified. For hemiarthroplasty patients, the mFI-5 strongly predicted risk of any complication (OR, 1.1; 95% CI, 1.1 to 1.2; P < 0.001), bleeding (OR, 1.2; 95% CI, 1.1 to 1.3; P < 0.001), and readmission (OR, 1.2; 95% CI, 1.1 to 1.3; P < 0.001). For THA patients, the mFI-5 was a strong predictor of any complication (OR, 1.2; 95% CI, 1.0 to 1.3; P = 0.023), pneumonia (OR, 1.4; 95% CI, 1.0 to 2.0; P = 0.047), and readmission (OR, 1.3; 95% CI, 1.1 to 1.6; P = 0.004). The mFI-5 is an independent predictor of morbidity and complications after hemiarthroplasty and THA for femoral neck fracture. Importantly, readmission risk was predicted by the mFI-5. The mFI-5 may present a valuable clinical tool for assessment of high-risk patients who might require additional resources and specialized care after femoral neck fracture.

Perioperative Morbidity Associated with Same-day Discharge in Elderly Patients.

We compared postoperative complications in elderly patients discharged on POD#0 versus POD#1 after prolapse repair. Data were obtained from the National Surgical Quality Improvement database. A total of 20,984 women 65years and older who underwent prolapse repair between 2014 and 2020 were analyzed. Patient demographics, comorbidities, readmission, reoperation, and 30-day postoperative complications were compared in patients discharged on POD#0 versus POD#1. A sensitivity analysis was completed to examine outcomes in patients who underwent an apical prolapse repair. Multivariate logistic regression was performed to evaluate for potential confounders. Age, race, ethnicity, American Society of Anesthesiologists class, prolapse repair type, and operative time were significantly different in patients discharged on POD#0 vs POD#1 (all p < 0.01). Patients discharged on POD#0 had significantly fewer postoperative complications (2.63% vs 3.44%) and readmissions (1.56% vs 2.18%, all p < 0.01). On multivariate regression modeling, postoperative discharge day was independently associated with complications, but not with readmissions or reoperation after. Patients who underwent an apical prolapse repair and were discharged on POD#0 had significantly more postoperative complications (3.5% vs 2.5%, p = 0.02) and readmissions (2.42% vs 10.08%, p < 0.01) than those discharged on POD#1. In this group, multivariate regression modeling demonstrated that postoperative discharge day was independently associated with any postoperative complication. For elderly women undergoing prolapse repair, the type of surgery should be considered when determining postoperative admission versus same-day discharge. Admission overnight does not seem to benefit women undergoing vaginal repairs but may decrease overall morbidity and risk of readmission in women undergoing an apical prolapse repair.

The role of hypertensive status in the preoperative patient selection of TSA

This study investigates the relationship between hypertension and postoperative complications following total shoulder arthroplasty (TSA). All patients who underwent TSA between 2015 and 2020 from the American College of Surgeons National Surgical Quality Improvement database were surveyed. The study population was divided into patients with no hypertension and patients with hypertension. Patient demographics, comorbidities, and 30-day postoperative complications were collected. Logistic regression analysis was used to investigate the relationship between hypertension and postoperative complications. Compared to no hypertension, hypertension was significantly associated with an increased likelihood of experiencing sepsis (P=.021), pneumonia (P=.019), myocardial infarction (P=.038), blood transfusions (P=.006), readmission (P<.001), reoperation (P<.001), non-home discharge (P<.001), and any complication (P<.001). After accounting for significant patient variables, compared to no hypertension, hypertension was independently significantly associated with an increased likelihood of experiencing reoperation (odds ratio 1.48; 95% CI, 1.142-1.905; P=.003) and any complication (odds ratio 1.10; 95% CI, 1.008-1.205; P=.033). In this study, we identified hypertension as an independent significant predictor for both reoperation and any complication following TSA. This study provides evidence for incorporating a patient's hypertensive status into preoperative screening, aiming to improve surgical candidate selection and surgical outcomes following TSA.

Predicting operative outcomes of total shoulder arthroplasty using the model for end-stage liver disease score

The aim of this study was to assess the efficacy of the Model for End-Stage Liver Disease (MELD) score in predicting postoperative complications following total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was subsequently classified into two categories: those with a MELD score ≥ 10 and those with a MELD score < 10. Atotal of 5265 patients undergoing TSA between 2015 and 2019 were included in this study. Among these, 4690 (89.1%) patients had a MELD score ≥ 10, while 575 (10.9%) patients had a MELD score < 10. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between a MELD score ≥ 10 and postoperative complications. The anchor based optimal cutoff was calculated by receiver operating characteristic analysis to determine the MELD score cutoff that most accurately predicts a specific complication. Youden's index (J) determined the optimal cutoff point calculation for the maximum sensitivity and specificity; these were deemed to be "acceptable" if the area under curve (AUC) was greater than 0.7 and "excellent" if greater than 0.8. Multivariate regression analysis found a MELD score ≥ 10 to be independently associated with higher rates of reoperation (OR, 2.08; P=.013), cardiac complications (OR, 3.37; P=.030), renal complications (OR, 7.72; P=.020), bleeding transfusions (OR, 3.23; P<.001), and nonhome discharge (OR, 1.75; P<.001). The receiver operating characteristic analysis showed that AUC for a MELD score cutoff of 7.61 as a predictor of renal complications was 0.87 (excellent) with sensitivity of 100.0% and specificity of 70.0%. AUC for a MELD score cutoff of 7.76 as a predictor of mortality was 0.76 (acceptable) with sensitivity of 81.8% and specificity of 71.0%. A MELD score ≥ 10 was correlated with high rates of reoperation, cardiac complications, renal complications, bleeding transfusions, and nonhome discharge following TSA. MELD score cutoffs of 7.61 and 7.76 were effective in predicting renal complications and mortality, respectively.

Cumulative effect of chronic dehydration and age on postoperative complications after total shoulder arthroplasty

Dehydration is a modifiable risk factor that should be optimized prior to all surgical procedures. The aim of this study was to determine the effects of dehydration on postoperative complications following total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019 and a total of 16,993 patients were included in this study. The study population was subsequently classified into 3 categories: 8498 (50.0%) nondehydrated patients with blood urea nitrogen/creatinine (BUN/Cr)<20, 4908 (28.9%) moderately dehydrated patients with 20≤BUN/Cr≤25, and 3587 (21.1%) severely dehydrated patients with 25<BUN/Cr. A subgroup analysis involving only elderly patients aged > 65 years and normalized gender-adjusted Cr values was also performed. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between dehydration and postoperative complications. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). The moderately dehydrated cohort had a greater risk of wound dehiscence (P=.044). Among the elderly, severely dehydrated patients had a greater risk of cardiac complications, postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). Finally, the elderly moderately dehydrated cohort had a greater risk of postoperative transfusion and nonhome discharge (all P<.05). BUN/Cr ratio is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning.

Predicting Mortality Following Odontoid Fracture Fixation in Elderly Patients: CAADS-16 Score.

Retrospective Review of a National Database. By utilizing a national database, this study aims to quantify the predictors of 30-day mortality after odontoid fixation and guide appropriate management for patients in whom the choice between operative and non-operative management is unclear. The American College of Surgeons National Surgical Quality Improvement Database was queried using Current Procedural Terminology (CPT) codes and International Classification of Disease (ICD) codes to identify patients 60 or older who underwent surgical fixation of an odontoid fracture from 2005 to 2020. Risk factors for mortality significant in univariate and subsequent multivariate analysis were used to develop a scoring system to predict post-operative mortality. 608 patients were identified. Patients were split into a non-mortality 30days post-op group, and into a mortality 30days post-op group. The following risk factors were included in the scoring system: functional dependency, disseminated cancer, albumin less than 3.5, WBC count greater than 16k, anterior surgical approach, and pre-op SIRS. Using a cutoff value of 2, the CAAD-16 score had a sensitivity and specificity of 82% and 81%, respectively. The ASA score, cutoff at 4, showed a sensitivity and specificity of 64% and 75% respectively. This sample of 294 patients represents one of the largest samples of odontoid fracture fixation patients available in the literature and comes from a nationally representative database. We structure relevant risk factors into the CAADS-16 score, which has the potential to be a clinically relevant tool to prevent short-term postoperative mortality.

Obesity Increases Risk for Wound Complications After Pediatric Foot Surgery: A Retrospective Cohort Review Using the NSQIP-Pediatric Database.

As the incidence of childhood obesity continues to rise, so too does the number of obese children who undergo foot surgery. As the childhood obesity epidemic rolls on, pediatric orthopaedic surgeons will encounter obese patients with even greater frequency. Therefore, a comprehensive understanding of the risks associated with obesity is valuable to maximize patient safety. The purpose of this study is to retrospectively evaluate the relationship between obesity and postoperative outcomes in patients undergoing pediatric foot surgery across multiple institutions using a large national database. Pediatric patients who had undergone foot surgery were retrospectively identified using the American College of Surgeons 2012-2017 Pediatric National Surgical Quality Improvement (ACS-NSQIP-Pediatric) database by cross-referencing reconstructive foot-specific CPT codes with ICD-9/ICD-10 diagnosis codes. Center for Disease Control BMI-to-age growth charts were used to stratify patients into normal-weight and obese cohorts. Univariate and multivariate analyses were performed to describe and assess outcomes in obese compared with normal-weight patients. Of the 3924 patients identified, 1063 (27.1%) were obese. Compared with normal-weight patients, obese patients were more often male (64.7% vs. 58.7%; P =0.001) and taller (56.3 vs. 51.3 inches; P <0.001). Obese patients had significantly higher rates of overall postoperative complications (3.01% vs. 1.32%; P =0.001) and wound dehiscence (1.41% vs. 0.59%; P =0.039). Multivariate analysis found that obesity was an independent predictor of both wound dehiscence [adjusted odds ratio (OR)=2.16; 95% CI=1.05-4.50; P =0.037] and surgical site infection (adjusted OR=3.03; 95% CI=1.39-6.61; P =0.005). Subgroup analysis of patients undergoing clubfoot capsular release procedures identified that obese patients had a higher rate of wound dehiscence (3.39% vs. 0.51%; P =0.039) compared with normal-weight patients. In multivariate analysis, obesity was an independent predictor of dehiscence (adjusted OR=5.71; 95% CI=1.46-22.31; P =0.012) in this procedure group. There were no differences in complication rates between obese and normal-weight patients in a subgroup analysis of tarsal coalition procedures or clubfoot tibialis anterior tendon transfer procedures. Obese children undergoing foot surgery had higher overall complication rates, wound complications, and surgical site infections compared with children of normal weight. As the incidence of childhood obesity continues to rise, this information may be useful in assessing and discussing surgical risks with patients and their families. III.

Comparing gynecologic oncologist versus general surgeon outcomes following bowel resections during cytoreductive surgery: A study of the national surgical quality improvement database (021)

Comparing gynecologic oncologist versus general surgeon outcomes following bowel resections during cytoreductive surgery: A study of the national surgical quality improvement database (021)

A comparison of financial and operational efficiency between smart and traditional insufflation for laparoscopic surgery: A granular analysis

ObjectiveSmart insufflation (SI) techniques relying on valve and membrane-free insufflation are increasing in usage. Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes, there remains a paucity describing the financial impact of these devices. The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room and inpatient wards of a hospital. MethodsA discrete event simulation model representing a typical mid-sized North American hospital comparing SI to traditional insufflation (TI) was generated. The National Surgical Quality Improvement database from 2015 to 2019 was used to populate the model with data supplemented from the literature. Outcomes included length of stay (LOS), duration of surgery (DOS), annual procedure volume, profit, return on investment (ROI), and gross profit margin (GPM). From the literature review, DOS savings were 10–32 minutes/case, while LOS savings were 0–3 days/case. ResultsImplementation of an SI led to an increase in annual throughput of 42–346 (4.4%–36.6%) cases for all procedures and 38 to 297 (4.3%–33.3%) cases for complex procedures. LOS was found to be decreased by 175–614 (18.3%–64.2%) days for all procedures and 231 to 614 (35.6%–77.9%) cases for complex procedures with the implementation of an SI. Together, this resulted in an increase in net profit of $104,685 per annum. The ROI of SI over the TI device was >1000%, and the GPM for the TI was 90.0%, while the GPM for the SI was 71.7%. ConclusionDespite the initial financial investment being greater, the implementation of SI offsets these expenses and yields significant financial benefits. Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analyses of technologies are essential to aid in sound healthcare procurement decision making.

Chronic Steroid Use, Complications, and Readmission Following Open Reduction Internal Fixation of Distal Radius Fracture

The increasing incidence of both distal radius fractures (DRFs) and chronic conditions thatnecessitate long-term steroid use has resulted in a growing intersection between the patientpopulations of the two. Chronic steroid use is known to increase bone frailty and thelikelihood of fractures but may also contribute to poorer outcomes following the repair of DRF. The purpose of this study was to investigate the association between preoperative chronic steroid use, postoperative complications, and readmission after open reduction internal fixation (ORIF) of DRF. The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent DRF ORIF between 2015 and 2021. However, 30-day postoperative complications after DRF ORIF were collected. Multivariate logistic regression analysis was conducted to investigate the relationship among preoperative chronic steroid use, postoperative complications, and patient factors associated with readmission. The postoperative complications associated with the steroid cohort were categorized as major, minor, and overall complications. Additionally, pneumonia, stroke, myocardial infarction, bleeding transfusions, deep vein thrombosis, pulmonary embolism, readmission, non-home discharge, and mortality were recorded. Chronic steroid use was found to be independently associated with major , minor, and overall complications, deep vein thrombosis, and readmission. Further investigation of readmission showed that male sex and comorbid chronic obstructive pulmonary disease were the only two patient factors independently associated with a greater likelihood of readmission after DRF ORIF. Preoperative chronic steroid use was associated with an increasing rate of postoperative complications after DRF ORIF. Male sex and comorbid chronic obstructive pulmonary disease were characteristics of chronic steroid-use patients independently associated with increased risk of readmission after DRF ORIF. A better understanding of preoperative chronic steroid use as a risk factor for postoperative complications may allow surgeons to improve preoperative risk stratification and patient counseling in the management of DRF. Prognostic III.

Resident Involvement in Shoulder-Stabilization Procedures Is Not Associated With an Increased Risk of 30-Day Postoperative Complications

To examine the 30-day postoperative outcomes of resident involvement in shoulder-stabilization surgical procedures using the American College of Surgeons National Surgical Quality Improvement database. We conducted a retrospective review of the National Surgical Quality Improvement database for all shoulder-stabilization procedures from 2010 to 2018. Procedures included arthroscopic Bankart, arthroscopic Bankart with SLAP repair, arthroscopic Bankart with Remplissage, open Bankart, anterior bone block, posterior bone block, Latarjet coracoid process transfer, and capsular shift/capsulorrhaphy for multidirectional instability. Data included preoperative demographics, comorbidities, and 30-day postoperative outcomes. Cases were categorized into 2 groups: "attending alone" and "attending and resident." Statistical analysis comparing groups on demographics and comorbidities included independent t-test for continuous variables and Pearson χ2 or Fischer exact for categorical variables. A logistic regression model including propensity score was used to calculate adjusted odds ratio for outcomes. A total of 3,954 patients undergoing shoulder-stabilization procedures were included in the study and 28.8% of patients had a resident involved intheir procedure. Residents were more likely to be involved in procedure for patients who were of minority ethnicity (P<.001), a lower body mass index (P < .001) and less likely to have a history of chronic obstructive pulmonary disease (P= .029). Resident involvement resulted in statistically significant longer total operation time (91 vs 85 minutes, P < .001). In terms of postsurgical outcomes, complication rates were low for both groups (∼0.8%). Resident involvement was not associated with any significant increase in 30-day postsurgical complications. Our results show that resident involvement in shoulder-stabilization surgery is associated with a significant increase in operative time without any significant increase in 30-day postsurgical complications. Level III, retrospective comparative study.

180. Did The National Ban On Bacitracin Irrigation Affect Infection Rates In Implant-based Breast Reconstruction? An Analysis Of A National Database

PURPOSE: The current standard of practice in implant-based breast reconstruction is irrigation of the mastectomy pocket with antimicrobial solution before implant placement. Prior to being banned and formally recalled in January 2020, bacitracin was a very commonly utilized antibiotic. This study characterizes the effects of the national bacitracin ban on implant-based breast reconstruction infection rates by using a nationwide database to compare complication rates before and after bacitracin was banned. METHODS: The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried retrospectively for all patients who underwent implant-based breast reconstruction before the bacitracin ban (2012-2019) and afterwards (2020). Demographics, comorbidities, and complications were collected. Univariate analysis and multivariate analysis were conducted to determine if there were significant changes in wound complications, local wound infections, and systemic infections between the two case-control matched cohorts. RESULTS: A total of 37,126 patients were in the pre-ban cohort and 6,333 patients were in the post-ban cohort. Before matching, there were significant differences in race distribution, BMI, ASA class, inpatient versus outpatient status, preoperative smoking, and preoperative diabetes mellitus (all p<0.05). After case-control matching, there were 6,313 patients in each cohort. Univariate analysis revealed differences in postoperative superficial and organ space surgical site infection, wound complications/infections, all cause complications, and reoperations (all p<0.05). Multivariate analysis showed that patients who underwent breast reconstruction before the ban had decreased odds of having wound infections, related infections, all cause complications, and reoperations (all p<0.05). CONCLUSION: This study provides a macroscopic view into the effects of the formal injectable bacitracin ban on breast reconstruction outcomes. Patients who underwent implant-based breast reconstruction after the ban of injectable bacitracin had higher odds of developing wound infections, related infections, and reoperations. More study into suitable alternatives to injectable bacitracin for surgical site antimicrobial irrigation is warranted.

MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019 Krishna Ravivarapu, Micah Levy, Christopher Connors, Daniel Wang, Chih Peng Chin, Evan Garden, Olamide Omidele, Francisca Larenas, and Michael Palese Krishna RavivarapuKrishna Ravivarapu More articles by this author , Micah LevyMicah Levy More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Daniel WangDaniel Wang More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Evan GardenEvan Garden More articles by this author , Olamide OmideleOlamide Omidele More articles by this author , Francisca LarenasFrancisca Larenas More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have compared complication rates following artificial urinary sphincter implantation (AUS) and male urethral sling placement (MUS). To the best of our knowledge, this is the first population-based comparative analysis of ambulatory AUS and MUS. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement database from 2016 to 2019 was used to identify all patients who underwent AUS (CPT 53445) and MUS (CPT 53440). Ambulatory surgery patients were selected based on a total hospital length of stay of zero days. We compared baseline characteristics, complication rates, reoperations, and readmissions between ambulatory AUS and MUS cohorts. Multivariate regression analysis controlling for available demographic and comorbidity data was used to evaluate the relationship between procedure type and adverse events. RESULTS: A total of 963 AUS and 550 MUS surgeries were analyzed. Of these, surgery was performed on an ambulatory basis for 27.7% (n=267) of AUS and 60.5% (n=333) of MUS cases. There were no statistically significant changes in utilization of same-day discharge for AUS (p=0.33) or MUS (p=0.82) from 2016 to 2019. Compared to patients undergoing ambulatory MUS, ambulatory AUS patients were more likely to be over 65 years old (74.7% vs. 64.9%), White race (77.7% vs. 58.9%), hypertensive (63.8% vs. 55.6%), insulin-dependent (9.4% vs. 3.9%), chronic steroid users (5.3% vs. 2.1%), and diagnosed with disseminated cancer (2.3% vs. 0.3%) (all p<0.05). There was no difference in overall 30-day complication rates (3.4% AUS vs. 3.3% MUS, p=0.91). Likewise, there were no significant differences in Clavien-Dindo I/II rates (3.0% AUS vs. 2.4% MUS, p=0.64) or Clavien-Dindo IV rates (0.4% AUS vs. 0.9% MUS, p=0.44). There was no significant difference in 30-day reoperation rates (2.3% AUS vs. 1.8% MUS, p=0.69). There was a trend towards higher rates of 30-day readmission rate for ambulatory AUS at 3.4% versus 1.5% for MUS (p=0.13). However, after controlling for patient demographics and comorbidities on multivariate regression analysis, undergoing ambulatory AUS versus MUS did not confer significantly increased odds of 30-day complication (OR 0.71, 95% CI 0.25-1.97, p=.51), reoperation (OR 1.03, 95% CI 0.30-3.61, p=.96), or readmission (OR 1.75, 95% CI 0.45-6.77, p=.42). CONCLUSIONS: Using a national database, we found no significant differences in 30-day complication, reoperation, or readmission rates between ambulatory AUS and MUS. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1019 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna Ravivarapu More articles by this author Micah Levy More articles by this author Christopher Connors More articles by this author Daniel Wang More articles by this author Chih Peng Chin More articles by this author Evan Garden More articles by this author Olamide Omidele More articles by this author Francisca Larenas More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Preoperative Serum Albumin Level Predicts Length of Stay and Perioperative Adverse Events Following Vertebral Corpectomy and Posterior Stabilization for Metastatic Spine Disease.

Retrospective review of a prospectively collected national database. To determine the association between preoperative serum albumin levels and perioperative adverse events (AEs) following vertebral corpectomy and posterior stabilization for metastatic spine disease. The 2010 to 2019 American College of Surgeons' National Surgical Quality Improvement (ACS-NSQIP) database was used to identify all patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Receiver operative characteristic (ROC) curve analysis was used to determine preoperative serum albumin cut-off values for predicting perioperative AEs. Low preoperative serum albumin was defined as serum albumin below this cut-off value. A total of 301 patients were included in the study. ROC curve analysis demonstrated serum albumin < 3.25g/dL as a cut-off value for predicting perioperative AEs. The low serum albumin group had a higher overall perioperative AEs (P = .041), longer post-operative LOS (P < .001), higher 30-day reoperation rate (P = .014), and a higher in-hospital mortality rate (P = .046). Multivariate analysis demonstrated that low preoperative serum albumin was associated with higher perioperative AEs. Low serum albumin level is associated with higher perioperative AEs, longer postoperative LOS, and higher rates of 30-day reoperation and in-hospital mortality among patients undergoing vertebral corpectomy and posterior stabilization for metastatic spine disease. Strategies to improve preoperative nutritional status in patients undergoing this procedure may improve these perioperative outcome measures within this surgical population. III.

The association between obesity and postoperative outcomes in a broad surgical population: A 7-year American College of Surgeons National Surgical Quality Improvement analysis

BackgroundThe number of obese surgical patients continues to grow, and yet obesity’s association with surgical outcomes is not totally clear. This study examined the association between obesity and surgical outcomes across a broad surgical population using a very large sample size. MethodsThis was an analysis of the 2012 to 2018 American College of Surgeons National Surgical Quality Improvement database, including all patients from 9 surgical specialties (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, and vascular). Preoperative characteristics and postoperative outcomes were compared by body mass index class (normal weight 18.5–24.9 kg/m2, overweight 25.0–29.9, obese class I 30.0–34.9, obese II 35.0–39.9, obese III ≥40). Adjusted odds ratios were computed for adverse outcomes by body mass index class. ResultsA total of 5,572,019 patients were included; 44.6% were obese. Median operative times were marginally higher for obese patients (89 vs 83 minutes, P < .001). Compared to normal weight patients, overweight and obese patients in classes I, II, and III all had higher adjusted odds of developing infection, venous thromboembolism, and renal complications, but they did not exhibit elevated odds of other postoperative complications (mortality, overall morbidity, pulmonary, urinary tract infection, cardiac, bleeding, stroke, unplanned readmission, or discharge not home (except for class III patients). ConclusionObesity was associated with increased odds of postoperative infection, venous thromboembolism, and renal but not the other American College of Surgeons National Surgical Quality Improvement complications. Obese patients need to be carefully managed for these complications.

Association of Comorbidities and Functional Level With Mortality in Geriatric Bowel Perforation

IntroductionSpontaneous bowel perforation is associated with high morbidity and mortality. This entity remains understudied in the geriatric patient. We sought to use a national surgical sample to uncover independent predictors of mortality in elderly patients undergoing emergent operation for perforated bowel. MethodsUsing the American College of Surgeons National Surgical Quality Improvement database, years 2007 to 2017, all geriatric patients (age ≥65 y) who underwent emergency surgery and who had a postoperative diagnosis of bowel perforation were included. Univariate and multivariable analyses were used to identify independent predictors of 30-d mortality. ResultsA total of 8981 patients were included. The median (interquartile range) age was 75 y (69, 82), and 59.0% were female. Twenty-one percent of patients were partially or totally dependent, and 25.2% were admitted from sources other than home. Overall, 30-d mortality rate was 22.1%. Independent predictors of mortality included the following: age 70-79 y (odds ratio [OR]: 1.59, P < 0.001), age ≥80 y (OR: 3.23, P < 0.001), American Society of Anesthesiologists ≥3 (OR: 4.74, P < 0.001), admission from chronic care facility (OR: 1.61, P < 0.001), being partially or totally dependent (OR: 1.50, P < 0.001), chronic steroid use (OR: 1.36, P < 0.001), and preoperative septic shock (OR: 3.74, P < 0.001). Having immediate fascial closure was protective against mortality (immediate fascial closure only, OR: 0.55, P < 0.001; -immediate closure of all surgical site layers, OR: 0.44, P < 0.001). ConclusionsIn geriatric patients, functional status and chronic steroid therapy play an important role in determining survival following surgery for bowel perforation. These factors should be considered during preoperative counseling and decision-making.