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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 1/2015

01-01-2015 | 2014 SSAT Plenary Presentation

Prevalence, Impact, and Risk Factors for Hospital-Acquired Conditions after Major Surgical Resection for Cancer: A NSQIP Analysis

Authors: Daniela Molena, Benedetto Mungo, Miloslawa Stem, Richard L. Feinberg, Anne O. Lidor

Published in: Journal of Gastrointestinal Surgery | Issue 1/2015

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Abstract

Background

The effectiveness of the CMS nonpayment policy for certain hospital-acquired conditions (HAC) is debated, since their preventability is questionable in several groups of patients. This study aimed to determine the rate of the three most common HAC in major surgical resections for cancer: surgical site infection (SSI), urinary tract infection (UTI), and venous thromboembolism (VTE). Additionally, the association of HAC with patients’ characteristics and their effect on post-operative outcomes were investigated.

Methods

Patients who underwent surgical resection for esophageal, gastric, hepato-biliary, pancreatic, colorectal, and lung cancer were identified using the ACS-NSQIP database (2005–2012). Early surgical outcomes were compared between HAC and non-HAC patients. Modified Poisson regression was used to identify risk factors for developing HAC.

Results

Seventy-four thousand three hundred eighty-one patients were identified, of whom 9,479 (12.74 %) developed one or more HAC. HAC patients had significantly higher rates of 30-day mortality, return to operating room, 30-day readmission, had longer LOS, and were less likely to be discharged home. Several peri-operative patients’ factors were significantly associated with HAC.

Conclusion

Our data show that the development of HAC is strongly associated to pre-operative patients’ characteristics and not only to sub-optimal peri-operative care, therefore suggesting that the nonpayment policy might be excessively penalizing.
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Literature
1.
Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Institute of Medicine (US) Committee on Quality of Health Care in America 2000, Washington, DC: National Academies Press
2.
Mello et al. Who pays for medical errors? An analysis of adverse event costs, medial liability system and incentives for patient safety improvement. Journal of Empirical Legal Studies 2007;4–4: 835–860CrossRef
3.
Weeks WB, Wallace AE. Broadening the business case for patient safety. Arch Intern Med 2003;163:1112; author reply 1113PubMedCrossRef
4.
5.
Lee GM, Kleinman K, Soumerai SB, Tse A, Cole D, Fridkin SK, Horan T, Platt R, Gay C, Kassler W, Goldmann DA, Jernigan J, Jha AK. Effect of nonpayment for preventable infections in U.S. hospitals. N Engl J Med 2012;367:1428–1437.PubMedCrossRef
6.
7.
Patel JD, Krilov L, Adams S, Aghajanian C, Basch E, Brose MS, Carroll WL, de Lima M, Gilbert MR, Kris MG, Marshall JL, Masters GA, O’Day SJ, Polite B, Schwartz GK, Sharma S, Thompson I, Vogelzang NJ, Roth BJ. Clinical Cancer Advances 2013: annual report on progress against cancer from the American Society of Clinical Oncology. J Clin Oncol 2014;32:129–160.PubMedCrossRef
8.
9.
10.
Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. The Lancet Oncology 2005;6:401–410.PubMedCrossRef
11.
Stahl M, Walz MK, Stuschke M, Lehmann N, Meyer HJ, Riera-Knorrenschild J, Langer P, Engenhart-Cabillic R, Bitzer M, Konigsrainer A, Budach W, Wilke H. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 2009;27:851–856.PubMedCrossRef
12.
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–646.PubMedCrossRef
13.
van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A, CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366:2074–2084.
14.
Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS. Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg 2011;201:305–8; discussion 308–9.PubMedCrossRef
15.
Palesty JA, Dudrick SJ. Cachexia, malnutrition, the refeeding syndrome, and lessons from Goldilocks. Surg Clin North Am 2011;91:653–673.PubMedCrossRef
16.
Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med 2005;118:978–980.PubMedCrossRef
17.
Waisbren E, Rosen H, Bader AM, Lipsitz SR, Rogers SO,Jr, Eriksson E. Percent body fat and prediction of surgical site infection. J Am Coll Surg 2010;210:381–389.
18.
Duska LR, Garrett L, Henretta M, Ferriss JS, Lee L, Horowitz N. When ‘never-events’ occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes. Gynecol Oncol 2010;116:374–377.PubMedCrossRef
19.
Chan JY, Semenov YR, Gourin CG. Postoperative urinary tract infection and short-term outcomes and costs in head and neck cancer surgery. Otolaryngol Head Neck Surg 2013;148:602–610.PubMedCrossRef
20.
Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009;250:363–376PubMed
Metadata
Title
Prevalence, Impact, and Risk Factors for Hospital-Acquired Conditions after Major Surgical Resection for Cancer: A NSQIP Analysis
Authors
Daniela Molena
Benedetto Mungo
Miloslawa Stem
Richard L. Feinberg
Anne O. Lidor
Publication date
01-01-2015
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2642-x

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