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01-06-2014 | Healthcare Policy and Outcomes

Impact of Hepatectomy Surgical Complexity on Outcomes and Hospital Quality Rankings

Authors: Jennifer L. Paruch, MD, Ryan P. Merkow, MD, MS, David J. Bentrem, MD, Clifford Y. Ko, MD, MS, MSHS, Mitchell C. Posner, MD, Mark E. Cohen, PhD, Karl Y. Bilimoria, MD, MS, Sharon M. Weber, MD, MS

Published in: Annals of Surgical Oncology | Issue 6/2014

Abstract

Background

There is substantial variation in the surgical complexity of hepatectomy. Currently, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk adjusts for hospital quality comparisons using only the primary procedure code. Our objectives were to (1) assess the association between secondary procedures and complications; (2) assess model performance with inclusion of surgical complexity adjustment; and (3) examine whether secondary procedures affect hospital quality rankings.

Methods

Using ACS NSQIP (2007–2012), patients undergoing hepatectomy were identified. Secondary procedure codes and total work relative value units (RVUs) were used to approximate procedural complexity. The effect of procedural complexity variables on outcomes and hospital quality rankings were examined using hierarchical models.

Results

Among 11,826 patients who underwent hepatectomy at 261 hospitals, 32.8 % underwent at least one secondary procedure. Serious morbidity occurred in 18.0 % of patients. Seven of nine secondary procedures were significantly associated with death or serious morbidity on multivariable analysis. Model performance improved when secondary procedure categories were included, and secondary procedure categories outperformed total RVUs. The C-statistic for death or serious morbidity was 0.689 in the standard NSQIP model, 0.703 when total RVU was included, and 0.718 when secondary procedure categories were included. Of the 26 hospitals that were poor performers for death or serious morbidity using the standard ACS NSQIP model, three became average performers when secondary procedure categories were included in the model.

Conclusions

Secondary procedures are associated with an increased risk of postoperative complications. Inclusion of secondary procedure code categories in research and risk prediction models should be considered for hepatectomy.

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Title: Impact of Hepatectomy Surgical Complexity on Outcomes and Hospital Quality Rankings
Authors: Jennifer L. Paruch, MD
Ryan P. Merkow, MD, MS
David J. Bentrem, MD
Clifford Y. Ko, MD, MS, MSHS
Mitchell C. Posner, MD
Mark E. Cohen, PhD
Karl Y. Bilimoria, MD, MS
Sharon M. Weber, MD, MS
Publication date: 01-06-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3500-5

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Springer Medicine

Impact of Hepatectomy Surgical Complexity on Outcomes and Hospital Quality Rankings

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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