National Surgical Quality Improvement Program Dataset Research Articles

Postconception age at surgery as a predictor of ventriculoperitoneal shunt failure.

The gold standard of pediatric hydrocephalus management is the ventriculoperitoneal (VP) shunt. However, VP shunts have high failure rates, and both young age and prematurity have been identified as potential risk factors for shunt failure, although neither variable describes total development at the time of surgery. This study aimed to further characterize age and shunt failure through the use of postconception age at surgery (PCAS) as well as investigate the 40-week PCAS threshold initially described in 1999. A retrospective analysis was conducted on all first-time shunt placements at the authors' institution from 2010 to 2021. The National Surgical Quality Improvement Program (NSQIP) pediatric hydrocephalus dataset was used as a parallel analysis to ensure representativeness of the national pediatric hydrocephalus population. In the institutional cohort, infants with a PCAS < 40 weeks exhibited 2.4 times greater odds of shunt failure than those with a PCAS ≥ 40 weeks. In the NSQIP dataset, infants with a PCAS < 40 weeks had 1.45 times greater odds of shunt failure compared with those with a PCAS ≥ 40 weeks. The 40-week PCAS threshold appears to be a significant predictor of shunt failure in pediatric patients with hydrocephalus. This finding underscores the importance of considering the developmental stage at the time of surgery, rather than just prematurity status, when assessing shunt failure risk.

MP13-02 COMPARING MFI-5, ASA CLASS, AND MCCI AS PREDICTORS OF POSTOPERATIVE OUTCOMES FOLLOWING ENDOSCOPIC TREATMENT OF BPH

You have accessJournal of UrologyCME1 Apr 2023MP13-02 COMPARING MFI-5, ASA CLASS, AND MCCI AS PREDICTORS OF POSTOPERATIVE OUTCOMES FOLLOWING ENDOSCOPIC TREATMENT OF BPH Justin James, Grace Jun, Jacob Gaines, Zeph Okeke, Gregory Mullen, and Arun Rai Justin JamesJustin James More articles by this author , Grace JunGrace Jun More articles by this author , Jacob GainesJacob Gaines More articles by this author , Zeph OkekeZeph Okeke More articles by this author , Gregory MullenGregory Mullen More articles by this author , and Arun RaiArun Rai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While frailty has emerged as a predictor of morbidity following urological surgery, it remains difficult to measure. A new frailty index (modified Frailty Index-5(mFI-5)) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH); however, its discriminatory abilities for postoperative complications has not been investigated. Therefore, we compared mFI-5 to two most commonly used indexes, the American Society of Anesthesiologists physical classification (ASA) and modified Charlson Comorbidity Index (mCCI) using the National Surgical Quality Improvement Program (NSQIP) database. METHODS: We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using CPT and ICD codes. Patients were stratified by procedure type (transurethral resection of the prostate (TURP), laser vaporization (LVP) and enucleation (LEP) of the prostate). Risk indexes were calculated and compared as predictors of postoperative outcomes using C-statistics (AUC). RESULTS: 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%, but upon stratifying by procedure, the complication rates were 11.0%, 10.3%, and 7.6% for TURP, LVP, and LEP, respectively. In aggregate, ASA Class, mFI-5, and mCCI were fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). ASA Class and mCCI were poor models (AUC: 0.6-0.7) for 30-day readmission and surgical complications; however, mFI-5 failed to model either postoperative outcome. All indexes failed to model any other postoperative outcomes (any complication, medical complications, reoperation, disease severity, length of stay ≥2 days) (AUC<0.6). Upon stratifying by endoscopic procedure, all three indexes remained fair models of mortality (AUC>0.7) and not superior to the other (p>0.05). Likewise, when stratifying by endoscopic procedure, all three indexes remained poor models for any readmissions and surgical complications (AUC>0.6). CONCLUSIONS: All three indexes are fair models of mortality for endoscopic treatment of BPH. However, these indexes were inadequate models for all other postoperative outcomes, despite previous studies demonstrating an association. Endoscopic treatment of BPH needs better risk indexes to predict post-operative complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e173 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin James More articles by this author Grace Jun More articles by this author Jacob Gaines More articles by this author Zeph Okeke More articles by this author Gregory Mullen More articles by this author Arun Rai More articles by this author Expand All Advertisement PDF downloadLoading ...

Mechanical bowel preparation and oral antibiotic bowel preparation in patients undergoing combined hysterectomy and bowel resection (002)

Mechanical bowel preparation and oral antibiotic bowel preparation in patients undergoing combined hysterectomy and bowel resection (002)

What Does Venous Thromboembolism Mean in the National Surgical Quality Improvement Program?

BackgroundVenous thromboembolism (VTE) affects an estimated 350,000 to 600,000 individuals and causes approximately 100,000 deaths annually in the United States. Postoperative VTE is a core measure reported by The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP). The objective of this research was to assess the validity of VTE events reported by NSQIP. Materials and methodsThis is a retrospective analysis using NSQIP data from January 2006 through December 2018 and the electronic health record system data from five adult hospitals in the Johns Hopkins Health System. We included patients aged 18 years and older with a VTE event identified in our NSQIP data set. The main outcome measure was the proportion of valid VTE events, defined as concordant between the NSQIP data set and medical chart review for clinical documentation. ResultsOf 474 patients identified in our NSQIP database with a VTE, 26 (5.5%) did not meet the strict NSQIP definition of VTE. Nine had a preoperative history of DVT and no new postoperative event, seven had a negative workup for VTE, six had a peripheral arterial thrombus, two did not receive or refused therapy, one had an aortic thrombus, and one had a venous thrombosis in a surgical flap. ConclusionsWe identified a considerable number of surgical patients misclassified as having a VTE in NSQIP, when did not truly. This highlights the need to improve definition specificity and standardize processes involved in data extraction, validation, and reporting to provide unbiased data for use in quality improvement.

The Use of Older Versus Newer Data in the National Surgical Quality Improvement Program Database Influences the Results of Total Hip Arthroplasty Outcomes Studies.

Introduction:National databases, such as the National Surgical Quality Improvement Program (NSQIP) database, are frequently used for total hip arthroplasty (THA) studies. NSQIP variables and the population included in the database have evolved over time. These changes may influence the results of studies using different periods of data.Methods:THA patients were aggregated from the 2005 to 2010 and 2011 to 2015 NSQIP data sets to define two era groups. Demographic data and 30-day perioperative outcomes were compared between the groups. As an example analysis, multivariate Poisson regression was used to determine the correlation between age and perioperative outcomes for each group.Results:Of 102,411 THA patients identified, 8098 cases were from 2005 to 2010 and 94,313 were from 2011 to 2015. A number of preoperative characteristics and perioperative outcomes were significantly different between the era groups. Multivariate analysis of the 2005 to 2010 group showed that increasing age was significantly associated with urinary tract infection and length of stay (LOS), and multivariate analysis of the 2011 to 2015 group showed that age was significantly associated with urinary tract infection, LOS, 30-day mortality, unplanned reintubation, extended LOS, pneumonia, deep vein thrombosis/thrombophlebitis, blood transfusion, and return to the operating room.Conclusion:Significantly more THA patients were enrolled in the NSQIP in the years between 2005 and 2015. Populations in 2005 to 2010 versus 2011 to 2015 were associated with differences in preoperative characteristics and perioperative outcomes. In an example analysis, it was shown that these differences together lead to different study results and conclusions. This needs to be considered when interpreting and conducting studies using earlier NSQIP data.

Major Complications and 30-Day Morbidity for Single Jaw Versus Bimaxillary Orthognathic Surgery as Reported by NSQIP

Acute complications in orthognathic surgery are reported in single-institution studies with small sample sizes. We aimed to analyze risk factors for acute complications using a national data set to better inform surgical decision-making. 2005-2015 National Surgical Quality Improvement Program (NSQIP) data sets were analyzed for patients undergoing Le Fort 1 and/or bilateral sagittal split osteotomies (BSSO) for nontraumatic indications. Demographics, comorbidities, medical, and surgical 30-day complications were tabulated. A logistic regression model was used to determine predictors of complications. Five hundred eight patients met the inclusion criteria: 228 underwent Le Fort I osteotomies, 152 BSSO, and 128 patients underwent both during a single surgical encounter. Overall complication rate was 4.5% (23/508). Superficial infection was the most common complication (11 in BSSO and 2 in Le Fort I cohorts). Increasing age and undergoing BSSO alone were associated with higher overall complication rates (P < .05) and surgical complications specifically (P < .05). Patients undergoing the combined procedure had shorter operative time (208 minutes) than the times for Le Fort I osteotomies alone (177 minutes) and BSSO alone (155 minutes) added together and did not have a longer hospital stay (P = .608) or increased need for transfusion (P = 1.0) compared to the surgeries being done separately. This is the first complication risk factor analysis for Le Fort I osteotomy and BSSO using the multi-institutional NSQIP data set. Combining BSSO and Le Fort I osteotomy leads to a shorter overall operative time and does not increase hospital stay duration or 30-day complication rate when compared to the 2 procedures being done separately.

Preoperatively predicting non-home discharge after surgery for gynecologic malignancy

ObjectiveReturning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy. MethodsWomen who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database. Patients were divided by discharge destination, and a multivariable logistic regression model was developed to create a nomogram to assign case-specific risk scores. The model was validated using the National Surgical Quality Improvement Program (NSQIP) database. ResultsNon-home discharge occurred in 3.1% of 2134 women. The proportion of non-home discharges did not differ by cancer diagnosis (uterine 3.5%, ovarian 2.5%, and cervical 1.6%, p = 0.2). Skilled nursing facilities were the most common non-home destination (68.2%). Among patients with comorbidities (hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease /dyspnea, arrhythmia, and history of deep vein thrombosis/pulmonary embolism), non-home discharge was more common in women with 1 (adjusted OR [aOR] 3.4; p = 0.03) or ≥2 of these comorbidities (aOR 5.1; p = 0.003) compared to none. Non-home discharge was more common after laparotomy (aOR 6.7; p < 0.0001) than laparoscopy, and in those aged ≥70 years (aOR 3.4; p < 0.0001) with American Society of Anesthesiologists class ≥ 3 (aOR 4.5; p = 0.0004) and dependent functional status (aOR 8.7; p < 0.0001). The model C-statistic was 0.89. When the model was applied to 4248 eligible patients from the NSQIP dataset, the C-statistic was 0.84 (95% CI: 0.79–0.89). ConclusionsNon-home discharge after surgery for gynecologic malignancy was predicted with high accuracy in this retrospective analysis.

Tobacco Use and Complications Following Spinal Fusion: A Comparison of the National Surgical Quality Improvement Program and National Inpatient Sample Datasets

Smoking is a known risk factor for inferior health outcomes. Retrospective analyses of large datasets may assess whether such risk is manifested or mitigated in clinical practice. Although many risk factor analyses use the National Surgical Quality Improvement Program (NSQIP) and National (Nationwide) Inpatient Sample (NIS), such investigations have seldom been directly compared. NIS and NSQIP datasets were used. Primary outcome measures were perioperative complications. NSQIP complications were stratified based on occurrence before versus after discharge. Multiple logistic regression was employed in adjusted analyses. Among NSQIP (N= 56,145) and NIS (N= 1,311,426) patients, 24.0% and 31.8% were identified as tobacco users, respectively. Before discharge, NSQIP smokers had increased odds of pneumonia (adjusted odds ratio [aOR]= 1.43), postoperative intubation (aOR= 1.40), and sepsis (aOR= 1.71) and decreased odds of pulmonary embolism (aOR= 0.57) (all P < 0.05). After discharge, NSQIP smokers exhibited increased odds of cardiac arrest (aOR= 2.53) and surgical site infection (aOR= 1.25) and decreased odds of urinary tract infection (aOR= 0.68) and deep venous thrombosis (aOR= 0.61) (all P < 0.05). In adjusted analysis of NIS data, tobacco users exhibited increased odds of inpatient pneumonia (aOR= 1.57), myocardial infarction (aOR= 1.29), and postoperative intubation (aOR= 1.15) and decreased odds of pulmonary embolism (aOR= 0.80) and deep venous thrombosis (aOR= 0.78) (all P < 0.05). Patients with a history of tobacco use undergoing spinal fusion were at increased risk of pneumonia and intubation but decreased risk of deep venous thrombosis and pulmonary embolism during the inpatient postoperative stay. After discharge, smokers exhibited increased odds of cardiac arrest and surgical site infection. NIS and NSQIP results were similar, with 9 of 12 outcomes exhibiting identical inpatient conclusions. Qualitative comparison of NIS and NSQIP yields results that offer increased validity over single-source studies.

Invited commentary

Invited commentary

Predictors of Nonneurologic Complications and Increased Length of Stay After Cervical Spine Osteotomy

Although previous studies have used National Surgical Quality Improvement Program (NSQIP) data to study complications of thoracolumbar spinal deformity surgery, investigation of cervical spine deformity surgery has been limited. We performed a retrospective analysis of the NSQIP database to identify predictors of complications after cervical spine osteotomy. Patients undergoing cervical spine osteotomy were identified in the NSQIP dataset using Current Procedural Terminology codes from years 2007-2016. For each patient, patient and case clinical characteristics, length of stay (LOS), and diagnosis of a nonneurologic complication (including reoperation and readmission) were abstracted. Patient and case clinical predictors of any of the reported complications and increased LOS were identified in multivariate logistic and Poisson regression analyses, respectively. There were 950 patients identified with mean age 56.1 ± 12.4 years and mean body mass index 29.9 ± 6.8. Mean LOS was 3.5 ± 4.9 days. Overall medical complication rate was 15.8%. The most common complications were transfusion (78; 8.2%), readmission (45; 4.7%), reoperation (32; 3.4%), and reintubation (28; 3.0%). Risk factors for any complication included increased age (P= 0.0467), American Society of Anesthesiologists classification III (P=0.0023) and IV (P= 0.0013), and increased operative duration (P < 0.0001). Risk factors for increased LOS weredecreased functional status (P= 0.0037), disseminated cancer (P= 0.0061), American Society of Anesthesiologists classification III and IV (P < 0.0001), increased operative duration (P < 0.0001), and orthopaedic surgeon (vs. neurosurgeon) (P= 0.0156). This study is the largest to date of patients undergoing cervical osteotomy and provides useful clinical data for patient selection and counseling and 30-day reoperation and readmission rates.

Similar 30-Day Complications for Septic Knee Arthritis Treated With Arthrotomy or Arthroscopy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

The purpose of the current study was to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to determine whether there were differences in 30-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic knees in a large national sample. Patients who were diagnosed with a septic knee and underwent open arthrotomy or arthroscopy were identified in the 2005-2014 NSQIP data sets. Patient demographics and perioperative complications were characterized and compared between the 2 procedures. In total, 168 patients undergoing knee arthrotomy and 216 patients undergoing knee arthroscopy for septic knee were identified. There were no statistically significant differences in demographic variables between the 2 groups. On univariate analysis, the rate of minor adverse events (MAEs; 15.48% vs 8.80%, P= .043) was higher in the open arthrotomy treatment group, while the rate of serious adverse events (SAEs; 37.50% vs 26.19%, P= .019) was higher in the arthroscopic surgery treatment group. On multivariate analysis, which controlled for patient characteristics/comorbidities and used the Bonferroni correction for multiple comparisons, there were no statistically significant differences in risk of any adverse events (relative risk [RR]= 0.851; 99% confidence interval [CI], 0.598-1.211; P= .240), MAE (RR= 1.653; 99% CI, 0.818-3.341; P= .066), SAE (RR= 0.706; 99% CI, 0.471-1.058; P= .027), return to the operating room (RR= 0.810; 99% CI, 0.433-1.516; P= .387), or readmission (RR= 1.022; 99% CI, 0.456-2.294; P= .944) between open compared with arthroscopic surgery. Univariate analysis revealed a lower rate of MAE but a higher rate of SAE in the arthroscopic surgery treatment group. However, on multivariate analysis, similar perioperative complications, rate of return to the operating room, and rate of readmission were found after open and arthroscopic debridement for septic knees. Based on the lack of demonstrated superiority of either of these 2 treatment modalities for this given diagnosis, and the expectation that most differences in perioperative complications for this diagnosis would have declared themselves within the first 30days, deciding between the studied treatment modalities may be based more on other factors not included in this study. Retrospective comparative study, Level III.

Minimally invasive hepatectomy conversions: An analysis of outcomes.

430 Background: Surgical approach has been described as a factor influencing morbidity in patients undergoing hepatectomy. Minimally invasive surgery (MIS) converted to open has previously been included in an open hepatectomy cohort of the National Surgical Quality Improvement Program (NSQIP) dataset for analysis. This study sought to compare MIS conversion to open hepatectomy cases and analyze factors leading to conversion. Methods: The NSQIP data set was queried for patients undergoing hepatectomy for liver disease between January 1, 2014 and December 31, 2014. Cases were divided into three cohorts: completely MIS (laparoscopic or robotic), open, or planned MIS converted to open approach according to the dataset definitions. Demographic, clinical-pathologic, and perioperative variables were described and short-term postoperative outcomes were compared between groups. Results: A total of 2,884 patients were identified. Open approach was performed most commonly (80.96%, n = 2,335), followed by minimally invasive (15.05%, n = 434) and MIS converted to open (3.99%, n = 115). Patients undergoing conversion were more likely to have higher BMI, hypertension, and hepatocellular carcinoma. Conversion patients suffered from significantly higher morbidity (p &lt; 0.001) compared to MIS, but had comparable outcomes to open procedures. Conclusions: MIS hepatectomy has been shown to have lower morbidity but similar mortality to open hepatectomy. Conversion procedures appear to have similar outcomes to open procedures, with greater morbidity compared to MIS. Differences in morbidity from previous studies may be partially attributed to the inclusion of conversions in the open hepatectomy cohort.

An unexpectedly high rate of revisions and removals in deep brain stimulation surgery: Analysis of multiple databases

IntroductionDeep brain stimulation (DBS) is an established therapy for movement disorders, and is under active investigation for other neurologic and psychiatric indications. While many studies describe outcomes and complications related to stimulation therapies, the majority of these are from large academic centers, and results may differ from those in general neurosurgical practice. MethodsUsing data from both the Centers for Medicare and Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP), we identified all DBS procedures related to primary placement, revision, or removal of intracranial electrodes. Cases of cortical stimulation and stimulation for epilepsy were excluded. ResultsOver 28,000 cases of DBS electrode placement, revision, and removal were identified during the years 2004–2013. In the Medicare dataset, 15.2% and of these procedures were for intracranial electrode revision or removal, compared to 34.0% in the NSQIP dataset. In NSQIP, significant predictors of revision and removal were decreased age (odds ratio (OR) of 0.96; 95% CI: 0.94, 0.98) and higher ASA classification (OR 2.41; 95% CI: 1.22, 4.75). Up to 48.5% of revisions may have been due to improper targeting or lack of therapeutic effect. ConclusionData from multiple North American databases suggest that intracranial neurostimulation therapies have a rate of revision and removal higher than previously reported, between 15.2 and 34.0%. While there are many limitations to registry-based studies, there is a clear need to better track and understand the true prevalence and nature of such failures as they occur in the wider surgical community.

Rectourethral fistulas: A comparison of the National Inpatient Sample and the American College of Surgeons National Surgical Quality Improvement Program

BackgroundThe National Surgical Quality Improvement Program (NSQIP) and the National Inpatient Sample (NIS) may be used to evaluate outcomes for uncommon conditions such as rectourethral fistulas (RUFs). We sought to review cases of RUFs and compare variables from both registries to evaluate disparities among reported data. MethodsReview of NSQIP (2005-2013) and NIS (2006-2011) of all patients with a RUF or RUF repair based on ICD-9-CM or CPT coding. ResultsThe NSQIP and NIS data sets were compared based on International Classification of Diseases, 9th Revision, Clinical Modification diagnosis coding for a RUF (599.1; American College of Surgeons National Surgical Quality Improvement Program: n = 286, NIS: n = 2,357). Comorbidities varied between data sets, and in-hospital morbidity in RUF cases was greater in the NIS vs NSQIP data sets (48% vs 11%; P < .01). Further analysis identified similar outcomes when cases of a RUF that underwent an operation were compared in the NSQIP (n = 284) and NIS (n = 274) database. ConclusionsThis study represents the largest cohort of RUF cases and characterizes how using variables from both databases better elucidates details of this rare condition. These results exhibit how evaluating comparable metrics demonstrates inconsistencies between databases.

Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease

Background ContextFrailty is defined as a state of decreased reserve and susceptibility to stressors. The relationship between frailty and postoperative outcomes after degenerative spine surgery has not been studied. PurposeThis study aimed to (1) determine prevalence of frailty in the degenerative spine population; (2) describe patient characteristics associated with frailty; and (3) determine the association between frailty and postoperative complications, mortality, length of stay, and discharge disposition. Study DesignThis is a retrospective analysis on a prospectively collected cohort from the National Surgical Quality Improvement Program (NSQIP). Patient SampleA total of 53,080 patients who underwent degenerative spine surgery between 2006 and 2012 were included in the study. Outcome MeasuresA modified frailty index (mFI) with 11 variables derived from the NSQIP dataset was used to determine prevalence of frailty and its correlation with a composite outcome of perioperative complications as well as hospital length of stay, mortality, and discharge disposition. MethodsAfter calculating the mFI for each patient, the prevalence and predictors of frailty were determined for our cohort. The association of frailty with postoperative outcomes was determined after adjusting for known and suspected confounders using multivariate logistic regression. ResultsFrailty was present in 2,041 patients within the total population (4%) and in 8% of patients older than 65 years. Frailty severity increased with increasing age, male sex, African American race, higher body mass index, recent weight loss, paraplegia or quadriplegia, American Society of Anesthesiologists (ASA) score, and preadmission residence in a care facility. Frailty severity was an independent predictor of major complication (OR 1.15 for every 0.10 increase in mFI, 95%CI 1.09–1.21, p<.0005) and specifically predicted reoperation for postsurgical infection (OR 1.3, 95%CI 1.16–1.46, p<.0005). Prolonged length of stay and discharge to a new facility were also independently predicted by frailty severity (p<.0005). Frailty severity predicted 30-day mortality on unadjusted (OR 2.05, 95%CI 1.70–2.48, p<.0005) and adjusted analyses (OR 1.48, 95%CI 1.18–1.86, p<.0005). ConclusionsFrailty is an important predictor of postoperative outcomes following degenerative spine surgery. Preoperative recognition of frailty may be useful for perioperative optimization, risk stratification, and patient counseling.

Improving Outcomes in Elective Colorectal Surgery: A Single-institution Retrospective Review

Our hospital, a Tennessee Surgical Quality Collaborative (TSQC) member, adopted a statewide colorectal care bundle intended to reduce surgical site infections (SSI) in elective colorectal cases. The bundle includes proper antibiotics/dosing, normoglycemia, normothermia, supplemental oxygen six hours postoperatively, and early enteral nutrition. A single-institution retrospective study of our National Surgical Quality Improvement Program (NSQIP) database for the rates of SSI before and after the colorectal bundle. We compared our SSI rates to TSQC hospitals as well as NSQIP datasets. Because of low case numbers in the NSQIP data, National Healthcare Safety Network (NHSN) data collected at our institution was used to compare our colorectal SSI before and after our colorectal bundle. From January 2010 to December 2011, 188 patients underwent nonemergent colorectal surgery in the NSQIP data. Of these, 5.4 per cent (10/188) developed superficial SSIs. During this same time, the rate of the TSQC superficial SSI was 7.1 per cent and NSQIP was 7.8 per cent. From January 2013 to October 2014, after the colorectal bundle started, 76 patients in NSQIP underwent nonemergent colorectal surgery. Of these, 6.5 per cent (5/76) developed superficial SSI, compared with 5.5 per cent in TSQC and 5.5 per cent in NSQIP. NHSN data showed a prebundle rate of 11 per cent and a postbundle rate of 3.5 per cent (P < 00.1, χ(2)). After adopting a colorectal bundle aimed at reducing SSIs, we did not improve our SSI rates in NSQIP; however, our NHSN data demonstrated considerable improvement. Differences in data collection may affect SSI rates, and ultimately "quality" based reimbursement. Implementation of the bundle did improve outcomes in colorectal surgery.

PD50-04 TRANSVAGINAL MESH INCREASES THE RISK OF BLEEDING AND ORGAN SURGICAL SITE INFECTION IN VAGINAL PELVIC RECONSTRUCTION SURGERY: RESULTS FROM A MULTI-INSTITUTIONAL PROSPECTIVELY MAINTAINED DATASET

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 2015PD50-04 TRANSVAGINAL MESH INCREASES THE RISK OF BLEEDING AND ORGAN SURGICAL SITE INFECTION IN VAGINAL PELVIC RECONSTRUCTION SURGERY: RESULTS FROM A MULTI-INSTITUTIONAL PROSPECTIVELY MAINTAINED DATASET Devin Haddad, Louis Krane, Gopal Badlani, and Majid Mirzazadeh Devin HaddadDevin Haddad More articles by this author , Louis KraneLouis Krane More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Majid MirzazadehMajid Mirzazadeh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vaginal reconstructive surgery can be performed with or without mesh based on surgeon preference. To elucidate small differences in perioperative morbidity following vaginal reconstructive procedures, we elected to look at a national dataset to determine whether using mesh during vaginal pelvic reconstruction surgery impacts rates of various perioperative complications and readmission. METHODS Using the National Surgical Quality Improvement Program (NSQIP) database we concatenated surgical data from multiple vaginal procedures, including anterior and posterior colporrhaphy, paravaginal defect repair, enterocele repair, and colpopexy using CPT coding. We stratified this data by the modifier associated with mesh usage at the time of the procedure. In measuring multiple covariates, we compared various 30-day perioperative outcomes, postoperative complications, and readmission rates. RESULTS We identified 5644 procedures without mesh and 1280 procedures using mesh in the NSQIP dataset from 2010 through 2012. Procedures using mesh had a higher rate of perioperative bleeding requiring transfusion than procedures not using mesh (2.11% vs 0.60%, p < 0.001). In the 27 cases using mesh that required blood transfusion, seven transfusions occurred the same day of surgery and 10 occurred on the first post-operative day. Procedures using mesh also had a higher rate of organ surgical site infection (0.55% vs 0.18%, p < 0.05). There were no significant differences in rates of readmission, superficial or deep surgical site infections, pneumonia, urinary tract infection, sepsis, pulmonary embolism, or renal failure. The data set does not capture surgeon or site specific complications or type of kits/trocars used with the mesh. CONCLUSIONS In a review of NSQIP data, vaginal pelvic reconstruction procedures using mesh have a higher rate of perioperative bleeding requiring transfusion and organ surgical site infection than procedures not using mesh. Patients undergoing these procedures should be counselled preoperatively concerning these risks. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1046-e1047 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Haddad More articles by this author Louis Krane More articles by this author Gopal Badlani More articles by this author Majid Mirzazadeh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP5-04 PERIOPERATIVE OUTCOMES OF TRANSURETHRAL RESECTION OF BLADDER TUMORS USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-04 PERIOPERATIVE OUTCOMES OF TRANSURETHRAL RESECTION OF BLADDER TUMORS USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE David C. Brooks, Devin A. Haddad, Robert C. Kovell, and Ryan P. Terlecki David C. BrooksDavid C. Brooks More articles by this author , Devin A. HaddadDevin A. Haddad More articles by this author , Robert C. KovellRobert C. Kovell More articles by this author , and Ryan P. TerleckiRyan P. Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.231AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Understanding risk factors for surgical complications associated with common urologic procedures is critical for developing strategies to improve patient care. In this report we analyze intraoperative parameters and perioperative outcomes of transurethral resections of bladder tumors (TURBTs) using the National Surgical Quality Improvement Program (NSQIP) database. METHODS Using the NSQIP dataset, we identified TURBTs performed from 2010 to 2012. We compared preoperative characteristics, surgical parameters, and 30-day perioperative outcomes. We stratified tumors as small, medium and large based on intraoperative surgeon assessment (CPT coding). To assess statistical significance we used chi square, t-test and ANOVA. RESULTS We identified 8116 TURBTs in the NSQIP database: 3533 small (43.3%), 2734 medium (33.5%) and 1849 large (22.6%). Significant differences in preoperative characteristics included higher rates of smoking, heart failure and renal failure in the large tumor group. Operations for large tumors were more likely to be done emergently (S=1.36%, M=1.39%, L=2.81%, p<0.01). Large tumors required longer operative times (S=25.8min, M=33.0min, L=49.0min, p <0.01) and longer hospitalizations (S=0.66days, M=1.1days, L=1.93days, p<0.01). Additionally, large tumors were associated with higher rates of blood transfusion (S=0.74%, M=1.54%, L=3.73%, p<0.01), sepsis (S=0.23%, M=0.44%, L=0.92%, p<0.01) and renal insufficiency (S= 0.17%, M=0.15%, L=0.59%, p<0.01), independent of pre-operative parameters. There was no difference in the rates of UTIs or thromboembolic events. Large tumors were associated with a higher rate of early post-operative readmissions (S=2.0%, M=2.7%, L=4.2%, p<0.01), overall morbidity (S=4.5%, M=6.5%, L=10.1%, p<0.01) and mortality (S=0.2%, M=1.1%, L=1.9%, p<0.01). CONCLUSIONS Overall complication rates for TURBTs were low. However, TURBT for large tumors is associated with increased operative times, length of hospitalization, overall morbidity, including increased rates of transfusion requirement, sepsis, renal insufficiency, and even mortality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e46 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David C. Brooks More articles by this author Devin A. Haddad More articles by this author Robert C. Kovell More articles by this author Ryan P. Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Crohn’s Disease but not Diverticulitis Is an Independent Risk Factor for Surgical Site Infections in Colectomy

IntroductionSurgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn’s disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set. MethodNSQIP data from 2006 to 2011 were investigated, and segmental colectomy procedures performed for the diagnoses of Crohn’s disease, DD, and colon malignancy were included. SSI complications were compared by diagnosis using univariate and multivariate analysis. ResultWe included 35,557 colectomy cases in the analysis. CD had the highest rate of postoperative SSI (17 vs. 13 % DD vs. 10 % CC; p < 0.001). Using CC as the comparison group and controlling for multiple variables, the multivariate analysis showed that the CD group had an increased risk for acquiring at least one SSI (odds ratio (OR) = 1.38, p ≤ 0.001), deep incisional SSI (OR = 1.85, p = 0.03), and organ space SSI (OR = 1.51, p = 0.02). ConclusionFor patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.

Impact of analysis of frozen-section margin on reoperation rates in women undergoing lumpectomy for breast cancer: Evaluation of the National Surgical Quality Improvement Program data

Reoperation for positive margins after lumpectomy for breast cancer is common. Intraoperative analysis of frozen-section (FS) margins permits immediate re-excision, avoiding reoperation. The aim of this study was to compare reoperation rates between an institution using routine FS analysis of all margins and the National Surgical Quality Improvement Program (NSQIP) data. We designed a retrospective cohort analysis comparing the NSQIP data from a FS single institution with the national NSQIP data from 2006 to 2010. Women undergoing lumpectomy for cancer were identified (N = 24,217), and reoperation rates were compared by the use of χ(2) analyses and multivariable logistic regression. During this time period, NSQIP did not differentiate between reoperations for complications or oncologic reasons. Reoperation rates for mastectomy patients (N = 21,734) and lumpectomy patients without cancer (N = 2,777) over the same time period were analyzed as controls, because reoperations after these procedures likely would be for reasons other than positive margins. The 30-day reoperation rate after lumpectomy for cancer was greater nationally than at the FS institution (13.2% vs 3.6%, P < .001). Multivariable analysis showed that patients in the national NSQIP data set were over four times as likely to undergo reoperation as those at the FS institution's (odds ratio 4.19). The reoperation rates were similar between the two, both for patients undergoing mastectomy (4.7% vs 4.5%, P = .84) and those undergoing lumpectomy for benign diagnosis (2.9% vs 5.9%, P = .39). Intraoperative FS margin analysis decreases the number of reoperations for patients undergoing breast conservation for breast cancer. This technique has important implications for patient satisfaction and cost of care.