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Timothy Feeney, Manuel Castillo-Angeles, John W Scott, Stephanie L Nitzschke, Ali Salim, Adil H Haider, Joaquim M Havens
BACKGROUND: Emergency general surgery (EGS) is an independent risk factor for morbidity and mortality, and seven procedures account for 80% of the National burden of operative EGS. We aimed to characterize the excess morbidity and mortality attributable to these procedures based on the level of procedural risk. METHODS: Retrospective analysis of the ACS National Surgical Quality Improvement Project (ACS-NSQIP) database. (2005-2014). Seven EGS procedures were stratified as high risk and low risk...
March 7, 2018: American Journal of Surgery
Nicholas P McKenna, Amy E Glasgow, Robert R Cima, Elizabeth B Habermann
BACKGROUND: Organ space infection (OSI) after ileal pouch anal anastomosis (IPAA) is a devastating complication. The aim of this was study was to determine separately risk factors for OSI after total proctocolectomy (TPC) with IPAA and completion proctectomy (CP) with IPAA. METHODS: 4049 patients with a diagnosis of chronic ulcerative colitis undergoing TPC with IPAA or CP with IPAA between 2005 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database...
March 6, 2018: American Journal of Surgery
Julie Hallet, Alyson L Mahar, Avery B Nathens, Melanie E Tsang, Kaitlyn A Beyfuss, Yulia Lin, Natalie G Coburn, Paul J Karanicolas
Background: Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry, we identified all adult patients undergoing elective hepatectomy over 2007-2012...
February 2018: Hepatobiliary Surgery and Nutrition
Pelumi Adedayo, Kimberly Resnick, Sareena Singh
OBJECTIVE: Our objective was to examine the association of the modified frailty index (mFI) and non-home discharge in patients undergoing surgery for endometrial cancer (EMCA). METHODS: Patients who underwent surgery for EMCA from 2011 to 2012 were identified from the American College of Surgeons - Nastional Surigical Quality Improvement Project (ACS-NSQIP) database. Current Procedural Terminology (CPT) codes were used to identify surgical characteristics. We excluded patients who were already living in a non-home facility...
March 9, 2018: Journal of Geriatric Oncology
Ayòtúndé B Fadayomi, Gyulnara G Kasumova, Omidreza Tabatabaie, Susanna W L de Geus, Tara S Kent, Sing Chau Ng, A James Moser, Mark P Callery, Stanley W Ashley, Jennifer F Tseng
BACKGROUND: Surgical site infections (SSIs) are common following pancreatectomy and associated with significant morbidity and economic burden. We sought to identify distinct predictors for superficial versus deep/organ space SSIs and their effects on surgical outcomes. METHODS: ACS-NSQIP targeted pancreatectomy 2014 and 2015 databases were queried. Univariate and multivariate models were developed for both types of SSI, length of stay (LOS), and readmission. Costs were estimated based on Centers for Medicare & Medicaid Services (CMS) recommendations...
March 8, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Chandrew Rajakumar, Ranjeeta Mallick, Glenn Posner, David Schramm, Sukhbir Singh, Karine Lortie, Dante Pascali, Innie Chen
OBJECTIVES: Due to the rapid decline in vaginal hysterectomy cases in recent years, there is concern regarding gynecologic surgical training and proficiency for vaginal hysterectomy. The objective of this study is to determine the effect of surgical trainee involvement on surgical outcomes in vaginal hysterectomy cases performed for benign indications. DESIGN: Retrospective, multicenter, cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database...
February 26, 2018: Journal of Minimally Invasive Gynecology
Nicholas G Berger, Josi L Herren, Chrissy Liu, Robert H Burrow, Jack P Silva, Susan Tsai, Kathleen K Christians, T Clark Gamblin
BACKGROUND AND OBJECTIVES: Ablation is a common treatment modality for malignant primary liver tumors(PLTs), outcomes following laparoscopic (LA) versus open ablation (OA) are ill-defined. This project compares peri-procedural outcomes of LA versus OA for PLTs. MATERIALS AND METHODS: Patients with PLTs undergoing radiofrequency ablation were queried from ACS NSQIP Database (2005-2013) using CPT codes. Patients undergoing percutaneous ablation or hepatic resection were excluded...
February 26, 2018: Journal of Surgical Oncology
Bruna Babic, Anita Ayrandjian Volpe, Stephen Merola, Elizabeth Mauer, Yaniv Cozacov, Clifford Y Ko, Fabrizio Michelassi, Pierre Saldinger
BACKGROUND: A focus on the culture of safety and patient outcomes continues to grow in importance. Several initiatives targeted at individual deficits have been described but few institutions have shown the effect of a global change in culture on patient outcomes. METHODS: Patient care perception was assessed using Safety Attitudes Questionnaire (SAQ) by Pascal Metrics® . A change in culture was initiated, followed by implementation of initiatives targeting communication and patient safety...
February 16, 2018: American Journal of Surgery
Faisal Aziz, Erik B Lehman
OBJECTIVES: Readmissions after surgical procedures are increasingly considered a metric to indicate the quality of care received during the index hospitalization. Patients with peripheral arterial disease requiring Peripheral Vascular Interventions (PVI) or Lower Extremity Bypasses (LEB) often have several serious medical comorbidities. Risk factors associated with readmission after PVI and LEB have previously been identified. The purpose of this study is to compare the readmissions among patients receiving PVI and LEB procedures to identify risk factors associated with high risk of readmission...
February 23, 2018: Annals of Vascular Surgery
Joyce C Zhang, John Matelski, Rajiv Gandhi, Timothy Jackson, David Urbach, Peter Cram
BACKGROUND: The "obesity paradox" is a phenomenon described in prior research in which patients who are obese have been shown to have lower postoperative mortality and morbidity compared with normal-weight individuals. The paradox is that clinical experience suggests that obesity is a risk factor for difficult wound healing and adverse cardiovascular outcomes. We suspect that the obesity paradox may reflect selection bias in which only the healthiest patients who are obese are offered surgery, whereas nonobese surgical patients are comprised of both healthy and unhealthy individuals...
February 14, 2018: Clinical Orthopaedics and related Research
Nathan R Elwood, Allison N Martin, Florence E Turrentine, R Scott Jones, Victor M Zaydfudim
BACKGROUND: This study aims to test associations between perioperative blood transfusion and postoperative morbidity and mortality after major abdominal operations. METHODS: The 2014 ACS NSQIP dataset was queried for all patients who underwent one of the ten major abdominal operations. Separate multivariable regression models, were developed to evaluate the independent effects of perioperative blood transfusion on morbidity and mortality. RESULTS: Of 48,854 patients in the study cohort, 4887 (10%) received a blood transfusion...
February 17, 2018: American Journal of Surgery
Aldene Zeno, Pedro Alvarez, Tajnoos Yazdany
INTRODUCTION: Associations between frailty and women with pelvic floor disorders (PFDs) are not well understood. This study seeks to describe studies among women with PFD and the associated frailty assessments as recommended in the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society (ACS NSQIP/AGS) guidelines. METHODS: This systematic review was registered with PROSPERO using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
Jeanie L Gribben, Nicole Ilonzo, Sean Neifert, I Michael Leitman
Background and Objectives: Morbidity and mortality have been shown to increase several-fold in patients who have undergone bariatric surgery and returned to the operating room after their initial procedures. Failure-to-rescue (FTR) analyses allow for an understanding of patient management and outcomes that is more distinguished than assessments of adverse occurrences and mortality rates alone. The objective of this study was to assess failure to rescue (FTR) and the characteristics and outcomes of patients undergoing reoperation after laparoscopic gastric bypass (LGBP) and laparoscopic sleeve gastrectomy (LSG)...
January 2018: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Eliza W Beal, Dmitry Tumin, Jeffery Chakedis, Erica Porter, Dimitrios Moris, Xu-Feng Zhang, Sherif Abdel-Misih, Mary Dillhoff, Andrei Manilchuk, Jordan Cloyd, Carl R Schmidt, Timothy M Pawlik
BACKGROUND: The objective of the current study was to define risk factors associated with the 30-day post-operative risk of VTE after HPB surgery and create a model to identify patients at highest risk of post-discharge VTE. METHODS: Patients who underwent hepatectomy or pancreatectomy in the ACS-NSQIP Participant Use Files 2011-2015 were identified. Logistic regression modeling was used; a model to predict post-discharge VTE was developed. Model discrimination was tested using area under the curve (AUC)...
February 19, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Madeline Lemke, Alyson Mahar, Paul J Karanicolas, Natalie G Coburn, Calvin H L Law, Julie Hallet
BACKGROUND: Risk of red blood cell transfusion (RBCT) in partial hepatectomy is 17-27%; strategies to reduce transfusions can be targeted in patients at increased risk. A Three Point Transfusion Risk Score (TRS) was previously developed to predict patients' risk of transfusion during and following hepatectomy. Here, it was subject to external validation using the ACS-NSQIP database. METHODS: TRIPOD guidelines were followed. A validation cohort was created with the ACS-NSQIP dataset...
February 16, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Holt S Cutler, Javier Z Guzman, Nathan J Lee, Parth Kothari, Jun S Kim, John I Shin, Dante M Leven, Samuel K Cho
Study Design: Retrospective study. Objective: Anterior fixation of odontoid fracture has been associated with high morbidity and mortality in small, single institution series. Identifying risk factors may improve risk stratification and highlight factors that could be optimized preoperatively. The objective of this study was to determine the 30-day complication rate following anterior fixation of odontoid fractures and to identify associated risk factors among patients in a large national database...
February 2018: Global Spine Journal
Olga Kantor, Henry A Pitt, Mark S Talamonti, Kevin K Roggin, David J Bentrem, Richard A Prinz, Marshall S Baker
BACKGROUND: Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes. METHODS: ACS-NSQIP 2014-2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed. RESULTS: Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions...
March 2018: Surgery
Yongjin F Lee, Jeremy Albright, Warqaa M Akram, Juan Wu, Jane Ferraro, Robert K Cleary
BACKGROUND: Laparoscopic conversion-to-open colorectal surgery is associated with worse outcomes when compared to operations completed without conversion. Consequences of robotic conversion have not yet been determined. The purpose of this study is to compare short-term outcomes of converted robotic colorectal cases with those that are completed without conversion, as well as with cases done by the open approach. METHODS: The ACS-NSQIP database was queried for patients who underwent robotic completed, robotic converted-to-open, and open colorectal resection between 2012 and 2015...
February 15, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Stephan N Salzmann, Peter B Derman, Lukas P Lampe, Janina Kueper, Ting Jung Pan, Jingyan Yang, Jennifer Shue, Federico P Girardi, Stephen Lyman, Alexander P Hughes
BACKGROUND: The rate of cervical spinal fusion has been increasing significantly. However, there is paucity of literature describing trends based on surgical approach using complete population databases. We investigated the approach-based trends in epidemiology, indications and in-hospital outcomes of cervical spinal fusion. METHODS: New York's Statewide Planning and Research Cooperative System database was queried to identify patients who underwent primary subaxial cervical fusion from 1997-2012...
February 10, 2018: World Neurosurgery
Ivy N Haskins, Jihad Kudsi, Kathleen Hayes, Richard L Amdur, Paul P Lin, Khashayar Vaziri
BACKGROUND: Surgical residency training programs in the United States are modeled on the principle of graduated responsibility. Residents are given greater responsibility and autonomy in the operating room and during perioperative care as they gain surgical skills and progress through their training. The impact of this method of surgical training on patient outcomes remains unknown. The purpose of this study is to compare early patient morbidity and mortality after bariatric surgery in cases with and without resident participation using the American College of Surgeons National Surgical Quality Improvement Program database...
March 2018: Journal of Surgical Research
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