ACS NSQIP National Conference 2013

SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.

At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.

For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.

Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.

"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."

By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.

Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.

Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.

Dr. McNelis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.

At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.

For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.

Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.

"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."

By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.

Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.

Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.

Dr. McNelis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – After enforcing existing protocols and other measures including compliance to ventilator bundles, clinicians in a surgical intensive care unit observed significant reductions in the rates of pneumonia and ventilator days through incorporation of NSQIP outcome data.

At the American College of Surgeons/National Surgical Quality Improvement Program National Conference, Dr. John McNelis presented results from a study that set out to improve the rates of postoperative pneumonia and prolonged ventilation at the 500-bed Winthrop University Hospital in Mineola, N.Y., "which were identified as problems in our postoperative surgery population," said Dr. McNelis, who is now chairman of surgery at Jacobi Medical Center in the Bronx.

For the study, two nurse reviewers collected ACS NSQIP data from 2010 to 2012, including demographic data, perioperative risk factors, laboratory data, and operative variables, as well as perioperative and postoperative events. Specific variables evaluated in surgical patients were mortality, cardiac events, pneumonia, being on a ventilator for more than 48 hours, thromboembolic events, renal failure, surgical site infection, and unplanned intubations. Data were reported as observed to expected odds ratio (O:E), with 1 being performance as expected given the patient’s severity.

Dr. McNelis noted that Winthrop is a university-affiliated teaching hospital as well as a regional trauma center with a surgical volume of 20,000 cases per year. After receiving their first semiannual ACS NSQIP report in July 2011, the O:E for pneumonia was 1.4, with an observed rate of 1.36%, while the O:E for being on a ventilator for more than 48 hours was 1.5, with an observed rate of 1.90%. In an effort to improve on those numbers, the researchers developed initiatives to decrease the duration of ventilation.

"Processes in the care of the ventilated patients were examined by a multispecialty work group based mostly out of the ICU and the surgical ICU," Dr. McNelis said. "We implemented a number of measures including enforcement of existing protocols, compliance to ventilator bundles, 24-hour weaning, extubating when ready, early nutrition, and early physical therapy including ambulation."

By the second semiannual report the O:E for prolonged ventilation dropped to 1.11, with an observed rate of 1.08%, while the O:E for pneumonia rose slightly to 1.48, with an observed rate of 1.4%. However, by the third semiannual report, the O:E for prolonged ventilation dropped further to 1.04, with an observed rate of 1.11%, while the O:E for pneumonia dropped to 1.25, with an observed rate of 1.2%.

Dr. McNelis said that given a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation, a decrease in observed rate for pneumonia from 1.36% to 1.2% would translate into 32 fewer cases of pneumonia in a hospital with an average surgical volume of 20,000, for an estimated savings of $707,104. At the same time, a decrease in the observed rate for ventilated patients from 1.9% to 1.11% would be associated with a net reduction of 160 episodes of prolonged intubation, for an estimated savings of $4,424,640.

Dr. McNelis acknowledged certain limitations of the study, including the sampling methodology, the fact that not all cases were captured, and that gains in one area could be offset by losses in another. He hopes to continue these initiatives at Jacobi Hospital.

Dr. McNelis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – In the opinion of Dr. Wayne J. English, it doesn’t take much for collaborative quality improvement projects to demonstrate a return on investment.

At the national conference of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), he discussed his experience as a member of the Michigan Bariatric Surgery Collaborative (MBSC), a clinical outcomes registry and quality improvement program funded by Blue Cross Blue Shield of Michigan (BCBS) "Hospitals across the state are collecting, sharing, and analyzing data, then designing and implementing changes to improve patient care, and it’s working," said Dr. English, medical director of bariatric surgery at the Bariatric and Metabolic Institute at Marquette (Mich.) General Hospital.

In 1997, a group of five hospitals in Michigan joined with Blue Cross Blue Shield of Michigan Foundation and Blue Care Network to collaborate on the study of variation in angiography procedures and treatment. Recommendations from the group’s analysis "contributed to dramatic decreases in coronary emergency bypass surgeries and other complications," Dr. English said. "The initiative also saved an estimated $102 million in statewide health costs over 3 years." Since then, 11 more initiatives have [been] launched to address many of the most common and costly areas of surgical and medical care in Michigan. These included cardiac imaging, vascular intervention, cardiothoracic surgery, trauma, general surgery, breast cancer, surgical outcomes, hospital medicine, knee/hip replacement, radiation oncology, and bariatric surgery.

Speaking in the context of his experience with the MBSC, Dr. English said that much of the success comes from the three-part approach to each initiative. First, funding from BCBS "enables hospitals to work in collaborative environment," he said. "BCBS provides resources for data collection and analysis along with administrative oversight."

Second, a separate coordinating center serves as a data warehouse, conducts data audits, performs data analyses, and generates comparative performance reports.

Third, participating hospitals "work together by sharing data and best practices to improve patient care throughout the state of Michigan," he said.

The MBSC collects data on perioperative care and outcomes, late outcomes, structure and process of care, technical quality, subjective aspects of quality, and cost. "There are site visits that occur on a regular basis," he said. "There are usually two surgeons and two nurses that go along on a site visit. We share ideas during those visits; these are collegial events."

The primary focus is the registry data. "We look at variation in practice and determine best evidence. We meet three times a year to analyze risk- and reliability-adjusted data, develop quality improvement projects and, ultimately, best practices," Dr. English said. Currently, the collaborative comprises 39 sites, 76 surgeons, and data on more than 40,000 patients. Approximately 6,500 patients are added into the database each year.

Notable outcomes from MBSC projects to date, he said, include a 24% decrease in complication rates from 2007 to 2009, a 35% decrease in readmission rates decreased from 2007 to 2009, and a 35% decreased in ED visits from 2007 to 2010. "The decline in ED visits alone resulted in overall savings for BCBS of Michigan of $4.7 million and an overall savings for statewide plans of $14.6 million," Dr. English said.

One of the first initiatives launched by the MBSC involved a quality improvement effort to reduce the rate of pulmonary embolism, which accounts for almost half of all deaths after bariatric surgery. Standard approaches to prophylaxis include early ambulation, compression stockings/devices, and anticoagulation.

"When we surveyed surgeons in the state of Michigan, we found that there was tremendous variation in how medical chemoprophylaxis was implemented," Dr. English noted. "Many surgeons were using low-molecular-weight heparin and/or unfractionated heparin to varying degrees preoperatively, postoperatively and post discharge, while some used none at all. So the collaborative data determined statistically significant patient risk factors and developed a VTE risk calculator to stratify the baseline risk for VTE. Once surgeons started participating and utilizing risk-stratified treatment guidelines, we started to see a downward trend on the rates of thromboembolic events."

A parallel initiative evaluated the impact of placing inferior vena cava (IVC) filters during bariatric surgery. The value of IVC filters as a prophylaxis in bariatric surgery patients "is unclear, but their use has been growing rapidly since the availability of removable filters," Dr. English said. "According to data from the collaborative, there was wide variability in utilization from never to almost 40% of patients receiving IVC filters."

After analyzing outcomes data from the MBSC, it was discovered that complication rates were significantly higher in patients who had IVC filters placed during bariatric surgery, compared with those who did not. "In fact, over half of deaths and permanent disability were directly attributable to the filter itself," he said. "Once provided with the initial data feedback, many surgeons started decreasing the use of IVC filters during bariatric surgery. Now, fewer than 2% use them."

MBSC data also showed that costs were about $13,000 less per case to perform gastric bypass procedures without the use of IVC filters. "As a result of this one quality improvement project, an estimated $1.3 million was saved over the course of 1 year while all Michigan payers saved an estimated $2.6 million over the course of 1 year," Dr. English said. "That savings is more than enough to cover the cost of operating MBSC each year."

Dr. English disclosed that he serves as a consultant for ReShape Medical.

[email protected]

SAN DIEGO – In the opinion of Dr. Wayne J. English, it doesn’t take much for collaborative quality improvement projects to demonstrate a return on investment.

At the national conference of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), he discussed his experience as a member of the Michigan Bariatric Surgery Collaborative (MBSC), a clinical outcomes registry and quality improvement program funded by Blue Cross Blue Shield of Michigan (BCBS) "Hospitals across the state are collecting, sharing, and analyzing data, then designing and implementing changes to improve patient care, and it’s working," said Dr. English, medical director of bariatric surgery at the Bariatric and Metabolic Institute at Marquette (Mich.) General Hospital.

In 1997, a group of five hospitals in Michigan joined with Blue Cross Blue Shield of Michigan Foundation and Blue Care Network to collaborate on the study of variation in angiography procedures and treatment. Recommendations from the group’s analysis "contributed to dramatic decreases in coronary emergency bypass surgeries and other complications," Dr. English said. "The initiative also saved an estimated $102 million in statewide health costs over 3 years." Since then, 11 more initiatives have [been] launched to address many of the most common and costly areas of surgical and medical care in Michigan. These included cardiac imaging, vascular intervention, cardiothoracic surgery, trauma, general surgery, breast cancer, surgical outcomes, hospital medicine, knee/hip replacement, radiation oncology, and bariatric surgery.

Speaking in the context of his experience with the MBSC, Dr. English said that much of the success comes from the three-part approach to each initiative. First, funding from BCBS "enables hospitals to work in collaborative environment," he said. "BCBS provides resources for data collection and analysis along with administrative oversight."

Second, a separate coordinating center serves as a data warehouse, conducts data audits, performs data analyses, and generates comparative performance reports.

Third, participating hospitals "work together by sharing data and best practices to improve patient care throughout the state of Michigan," he said.

The MBSC collects data on perioperative care and outcomes, late outcomes, structure and process of care, technical quality, subjective aspects of quality, and cost. "There are site visits that occur on a regular basis," he said. "There are usually two surgeons and two nurses that go along on a site visit. We share ideas during those visits; these are collegial events."

The primary focus is the registry data. "We look at variation in practice and determine best evidence. We meet three times a year to analyze risk- and reliability-adjusted data, develop quality improvement projects and, ultimately, best practices," Dr. English said. Currently, the collaborative comprises 39 sites, 76 surgeons, and data on more than 40,000 patients. Approximately 6,500 patients are added into the database each year.

Notable outcomes from MBSC projects to date, he said, include a 24% decrease in complication rates from 2007 to 2009, a 35% decrease in readmission rates decreased from 2007 to 2009, and a 35% decreased in ED visits from 2007 to 2010. "The decline in ED visits alone resulted in overall savings for BCBS of Michigan of $4.7 million and an overall savings for statewide plans of $14.6 million," Dr. English said.

One of the first initiatives launched by the MBSC involved a quality improvement effort to reduce the rate of pulmonary embolism, which accounts for almost half of all deaths after bariatric surgery. Standard approaches to prophylaxis include early ambulation, compression stockings/devices, and anticoagulation.

"When we surveyed surgeons in the state of Michigan, we found that there was tremendous variation in how medical chemoprophylaxis was implemented," Dr. English noted. "Many surgeons were using low-molecular-weight heparin and/or unfractionated heparin to varying degrees preoperatively, postoperatively and post discharge, while some used none at all. So the collaborative data determined statistically significant patient risk factors and developed a VTE risk calculator to stratify the baseline risk for VTE. Once surgeons started participating and utilizing risk-stratified treatment guidelines, we started to see a downward trend on the rates of thromboembolic events."

A parallel initiative evaluated the impact of placing inferior vena cava (IVC) filters during bariatric surgery. The value of IVC filters as a prophylaxis in bariatric surgery patients "is unclear, but their use has been growing rapidly since the availability of removable filters," Dr. English said. "According to data from the collaborative, there was wide variability in utilization from never to almost 40% of patients receiving IVC filters."

After analyzing outcomes data from the MBSC, it was discovered that complication rates were significantly higher in patients who had IVC filters placed during bariatric surgery, compared with those who did not. "In fact, over half of deaths and permanent disability were directly attributable to the filter itself," he said. "Once provided with the initial data feedback, many surgeons started decreasing the use of IVC filters during bariatric surgery. Now, fewer than 2% use them."

MBSC data also showed that costs were about $13,000 less per case to perform gastric bypass procedures without the use of IVC filters. "As a result of this one quality improvement project, an estimated $1.3 million was saved over the course of 1 year while all Michigan payers saved an estimated $2.6 million over the course of 1 year," Dr. English said. "That savings is more than enough to cover the cost of operating MBSC each year."

Dr. English disclosed that he serves as a consultant for ReShape Medical.

[email protected]

SAN DIEGO – In the opinion of Dr. Wayne J. English, it doesn’t take much for collaborative quality improvement projects to demonstrate a return on investment.

At the national conference of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), he discussed his experience as a member of the Michigan Bariatric Surgery Collaborative (MBSC), a clinical outcomes registry and quality improvement program funded by Blue Cross Blue Shield of Michigan (BCBS) "Hospitals across the state are collecting, sharing, and analyzing data, then designing and implementing changes to improve patient care, and it’s working," said Dr. English, medical director of bariatric surgery at the Bariatric and Metabolic Institute at Marquette (Mich.) General Hospital.

In 1997, a group of five hospitals in Michigan joined with Blue Cross Blue Shield of Michigan Foundation and Blue Care Network to collaborate on the study of variation in angiography procedures and treatment. Recommendations from the group’s analysis "contributed to dramatic decreases in coronary emergency bypass surgeries and other complications," Dr. English said. "The initiative also saved an estimated $102 million in statewide health costs over 3 years." Since then, 11 more initiatives have [been] launched to address many of the most common and costly areas of surgical and medical care in Michigan. These included cardiac imaging, vascular intervention, cardiothoracic surgery, trauma, general surgery, breast cancer, surgical outcomes, hospital medicine, knee/hip replacement, radiation oncology, and bariatric surgery.

Speaking in the context of his experience with the MBSC, Dr. English said that much of the success comes from the three-part approach to each initiative. First, funding from BCBS "enables hospitals to work in collaborative environment," he said. "BCBS provides resources for data collection and analysis along with administrative oversight."

Second, a separate coordinating center serves as a data warehouse, conducts data audits, performs data analyses, and generates comparative performance reports.

Third, participating hospitals "work together by sharing data and best practices to improve patient care throughout the state of Michigan," he said.

The MBSC collects data on perioperative care and outcomes, late outcomes, structure and process of care, technical quality, subjective aspects of quality, and cost. "There are site visits that occur on a regular basis," he said. "There are usually two surgeons and two nurses that go along on a site visit. We share ideas during those visits; these are collegial events."

The primary focus is the registry data. "We look at variation in practice and determine best evidence. We meet three times a year to analyze risk- and reliability-adjusted data, develop quality improvement projects and, ultimately, best practices," Dr. English said. Currently, the collaborative comprises 39 sites, 76 surgeons, and data on more than 40,000 patients. Approximately 6,500 patients are added into the database each year.

Notable outcomes from MBSC projects to date, he said, include a 24% decrease in complication rates from 2007 to 2009, a 35% decrease in readmission rates decreased from 2007 to 2009, and a 35% decreased in ED visits from 2007 to 2010. "The decline in ED visits alone resulted in overall savings for BCBS of Michigan of $4.7 million and an overall savings for statewide plans of $14.6 million," Dr. English said.

One of the first initiatives launched by the MBSC involved a quality improvement effort to reduce the rate of pulmonary embolism, which accounts for almost half of all deaths after bariatric surgery. Standard approaches to prophylaxis include early ambulation, compression stockings/devices, and anticoagulation.

"When we surveyed surgeons in the state of Michigan, we found that there was tremendous variation in how medical chemoprophylaxis was implemented," Dr. English noted. "Many surgeons were using low-molecular-weight heparin and/or unfractionated heparin to varying degrees preoperatively, postoperatively and post discharge, while some used none at all. So the collaborative data determined statistically significant patient risk factors and developed a VTE risk calculator to stratify the baseline risk for VTE. Once surgeons started participating and utilizing risk-stratified treatment guidelines, we started to see a downward trend on the rates of thromboembolic events."

A parallel initiative evaluated the impact of placing inferior vena cava (IVC) filters during bariatric surgery. The value of IVC filters as a prophylaxis in bariatric surgery patients "is unclear, but their use has been growing rapidly since the availability of removable filters," Dr. English said. "According to data from the collaborative, there was wide variability in utilization from never to almost 40% of patients receiving IVC filters."

After analyzing outcomes data from the MBSC, it was discovered that complication rates were significantly higher in patients who had IVC filters placed during bariatric surgery, compared with those who did not. "In fact, over half of deaths and permanent disability were directly attributable to the filter itself," he said. "Once provided with the initial data feedback, many surgeons started decreasing the use of IVC filters during bariatric surgery. Now, fewer than 2% use them."

MBSC data also showed that costs were about $13,000 less per case to perform gastric bypass procedures without the use of IVC filters. "As a result of this one quality improvement project, an estimated $1.3 million was saved over the course of 1 year while all Michigan payers saved an estimated $2.6 million over the course of 1 year," Dr. English said. "That savings is more than enough to cover the cost of operating MBSC each year."

Dr. English disclosed that he serves as a consultant for ReShape Medical.

[email protected]

SAN DIEGO – The overall 30-day morbidity rate following surgery for elective splenectomy for hematologic disorders is 13.6% while the overall 30-day mortality rate is 1.6%, results from an analysis of national data demonstrated.

While the morbidity rate was significantly higher for patients with malignant versus benign disease (19.6% vs. 11.9%, respectively), the mortality rate was similar between the two patient groups, Mary Belding-Schmitt reported at the American College of Surgeons/National Surgical Quality Improvement Program National Conference.

"There are limited data regarding complications and mortality following elective splenectomy, especially for malignant disease," said Ms. Belding-Schmitt, a staff nurse in the division of surgical oncology and endocrine surgery in the department of surgery at University of Iowa Hospitals and Clinics. "Most of the published studies are from single institution series and focus on primary splenic diseases. More recent data report a wide range of complications and mortality across different diseases treated with splenectomy."

In an effort to evaluate complications and mortality following elective splenectomy for benign and malignant hematologic disorders, she and her associates searched the ACS NSQIP database for patients who underwent elective splenectomy procedures from 2006 to 2011. Benign disease was defined as hemolytic anemia or thrombocytopenia, while malignant disease was defined as leukemia or lymphoma. The researchers excluded cases of nonelective splenectomy or splenectomy combined with another procedure. Perioperative clinicopathologic variables and operative complications were analyzed and compared between patients treated for benign and malignant hematologic disease.

Of the 4,859 splenectomy procedures identified from the data set, 1,762 cases met criteria for analysis. Of these, 1,379 operations were for benign conditions while 383 were for malignant conditions. Of the benign indications for splenectomy, most (73.5%) were for thrombocytopenia, 11.7% were for hemolytic anemia, and the remainder were for other conditions. Of the malignant indications for splenectomy, most (83.6%) were for lymphoma and 16.4% were for leukemia.

Patients with benign disease tended to be younger (a mean of 50 vs. 61 years, respectively), were more commonly female (58% vs. 43%), tended to be diabetic (15% vs. 12%), had a higher body mass index (a mean of 29.7 kg/m² vs. 27.3 kg/m²), received preoperative steroids (60% vs. 13%), and underwent significantly more laparoscopic procedures (82% vs. 39%; P less than .0001).

Ms. Belding-Schmitt reported that the rate of overall complications was significantly higher for patients with malignant vs. benign disease (19.6% vs. 11.9%, respectively; P = .0002), but there was no significant difference between the two groups in overall mortality (2.1% vs. 1.5%; P = .37). She characterized the 2.1% mortality rate as being similar to that following pancreatectomy in high-volume centers.

Patients with malignant disease tended to have a higher rate of infection complications (16% vs. 9%; P = .0002) and a longer median hospital length of stay (5 vs. 3 days; P = .0005).

Ms. Belding-Schmitt said that a multivariable analysis is underway to determine specific variables which account for significant morbidity and mortality from splenectomy for hematologic disorders. She said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – The overall 30-day morbidity rate following surgery for elective splenectomy for hematologic disorders is 13.6% while the overall 30-day mortality rate is 1.6%, results from an analysis of national data demonstrated.

While the morbidity rate was significantly higher for patients with malignant versus benign disease (19.6% vs. 11.9%, respectively), the mortality rate was similar between the two patient groups, Mary Belding-Schmitt reported at the American College of Surgeons/National Surgical Quality Improvement Program National Conference.

"There are limited data regarding complications and mortality following elective splenectomy, especially for malignant disease," said Ms. Belding-Schmitt, a staff nurse in the division of surgical oncology and endocrine surgery in the department of surgery at University of Iowa Hospitals and Clinics. "Most of the published studies are from single institution series and focus on primary splenic diseases. More recent data report a wide range of complications and mortality across different diseases treated with splenectomy."

In an effort to evaluate complications and mortality following elective splenectomy for benign and malignant hematologic disorders, she and her associates searched the ACS NSQIP database for patients who underwent elective splenectomy procedures from 2006 to 2011. Benign disease was defined as hemolytic anemia or thrombocytopenia, while malignant disease was defined as leukemia or lymphoma. The researchers excluded cases of nonelective splenectomy or splenectomy combined with another procedure. Perioperative clinicopathologic variables and operative complications were analyzed and compared between patients treated for benign and malignant hematologic disease.

Of the 4,859 splenectomy procedures identified from the data set, 1,762 cases met criteria for analysis. Of these, 1,379 operations were for benign conditions while 383 were for malignant conditions. Of the benign indications for splenectomy, most (73.5%) were for thrombocytopenia, 11.7% were for hemolytic anemia, and the remainder were for other conditions. Of the malignant indications for splenectomy, most (83.6%) were for lymphoma and 16.4% were for leukemia.

Patients with benign disease tended to be younger (a mean of 50 vs. 61 years, respectively), were more commonly female (58% vs. 43%), tended to be diabetic (15% vs. 12%), had a higher body mass index (a mean of 29.7 kg/m² vs. 27.3 kg/m²), received preoperative steroids (60% vs. 13%), and underwent significantly more laparoscopic procedures (82% vs. 39%; P less than .0001).

Ms. Belding-Schmitt reported that the rate of overall complications was significantly higher for patients with malignant vs. benign disease (19.6% vs. 11.9%, respectively; P = .0002), but there was no significant difference between the two groups in overall mortality (2.1% vs. 1.5%; P = .37). She characterized the 2.1% mortality rate as being similar to that following pancreatectomy in high-volume centers.

Patients with malignant disease tended to have a higher rate of infection complications (16% vs. 9%; P = .0002) and a longer median hospital length of stay (5 vs. 3 days; P = .0005).

Ms. Belding-Schmitt said that a multivariable analysis is underway to determine specific variables which account for significant morbidity and mortality from splenectomy for hematologic disorders. She said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – The overall 30-day morbidity rate following surgery for elective splenectomy for hematologic disorders is 13.6% while the overall 30-day mortality rate is 1.6%, results from an analysis of national data demonstrated.

While the morbidity rate was significantly higher for patients with malignant versus benign disease (19.6% vs. 11.9%, respectively), the mortality rate was similar between the two patient groups, Mary Belding-Schmitt reported at the American College of Surgeons/National Surgical Quality Improvement Program National Conference.

"There are limited data regarding complications and mortality following elective splenectomy, especially for malignant disease," said Ms. Belding-Schmitt, a staff nurse in the division of surgical oncology and endocrine surgery in the department of surgery at University of Iowa Hospitals and Clinics. "Most of the published studies are from single institution series and focus on primary splenic diseases. More recent data report a wide range of complications and mortality across different diseases treated with splenectomy."

In an effort to evaluate complications and mortality following elective splenectomy for benign and malignant hematologic disorders, she and her associates searched the ACS NSQIP database for patients who underwent elective splenectomy procedures from 2006 to 2011. Benign disease was defined as hemolytic anemia or thrombocytopenia, while malignant disease was defined as leukemia or lymphoma. The researchers excluded cases of nonelective splenectomy or splenectomy combined with another procedure. Perioperative clinicopathologic variables and operative complications were analyzed and compared between patients treated for benign and malignant hematologic disease.

Of the 4,859 splenectomy procedures identified from the data set, 1,762 cases met criteria for analysis. Of these, 1,379 operations were for benign conditions while 383 were for malignant conditions. Of the benign indications for splenectomy, most (73.5%) were for thrombocytopenia, 11.7% were for hemolytic anemia, and the remainder were for other conditions. Of the malignant indications for splenectomy, most (83.6%) were for lymphoma and 16.4% were for leukemia.

Patients with benign disease tended to be younger (a mean of 50 vs. 61 years, respectively), were more commonly female (58% vs. 43%), tended to be diabetic (15% vs. 12%), had a higher body mass index (a mean of 29.7 kg/m² vs. 27.3 kg/m²), received preoperative steroids (60% vs. 13%), and underwent significantly more laparoscopic procedures (82% vs. 39%; P less than .0001).

Ms. Belding-Schmitt reported that the rate of overall complications was significantly higher for patients with malignant vs. benign disease (19.6% vs. 11.9%, respectively; P = .0002), but there was no significant difference between the two groups in overall mortality (2.1% vs. 1.5%; P = .37). She characterized the 2.1% mortality rate as being similar to that following pancreatectomy in high-volume centers.

Patients with malignant disease tended to have a higher rate of infection complications (16% vs. 9%; P = .0002) and a longer median hospital length of stay (5 vs. 3 days; P = .0005).

Ms. Belding-Schmitt said that a multivariable analysis is underway to determine specific variables which account for significant morbidity and mortality from splenectomy for hematologic disorders. She said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – For thoracic surgery patients, being on neoadjuvant chemotherapy, having chronic obstructive pulmonary disease, and a weight loss of greater than 10% were all associated with the development of postoperative pneumonia, results from a single-center study showed.

At the national conference of the American College of Surgeons/National Surgical Quality Improvement Program, Dr. Elisabeth Dexter noted that after the first ACS/NSQIP data harvest at the Roswell Park Cancer Institute in Buffalo, N.Y., the risk of postoperative pneumonia was found to be 4.4%, compared with a rate of 1.1% in all other NSQIP hospitals.

"Of particular note, the thoracic surgery service had a high incidence of 13.2%," said Dr. Dexter, an attending surgeon in the department of thoracic surgery at the Institute. "The high incidence of our postoperative pneumonia was likely [affected] by our thoracic surgery service because our thoracic surgery service had an increased percentage of the abstracted NSQIP data in our cohort, from 12% to 14%, compared with other NSQIP hospitals of similar academic size abstracting 2%. When we found this high postoperative pneumonia rate, we decided to query our NSQIP data and our tumor registry between July 1, 2011, and Oct. 8, 2012, to ask the question: Is there an increased incidence of postoperative pneumonia in thoracic surgery patients who received neoadjuvant chemotherapy compared with those who did not?"

Dr. Dexter and her associates cross-referenced ACS/NSQIP data on 1,723 patients at the cancer center with the tumor registry. Of the 1,723 patients, 1,645 had no postoperative pneumonia while 78 did. Compared with the non-pneumonia patients, those who had pneumonia tended to be older (a mean of 67 vs. 60 years, respectively; odds ratio, 1.05; P less than .001), more likely to be male (59% vs. 37%; OR, 2.48; P less than .001), have chronic obstructive pulmonary disease (35% vs. 9%; OR, 5.08; P less than .001), be a smoker (36% vs. 24%; OR, 1.75; P = .021), and had lost more than 10% of body weight (10% vs. 2.5%; OR, 4.47; P less than .001).

On univariate analysis, postoperative pneumonia was associated with being on neoadjuvant chemotherapy (4.2% vs. 14%; OR, 3.75; P less than .001).

In addition, certain surgical subspecialties at the Institute had a high incidence of postoperative pneumonia, including thoracic surgery (46%), GI surgery (21%), and gynecology (12%).

When the researchers included the entire cohort of patients, those who were on neoadjuvant therapy had an increased incidence of postoperative pneumonia, compared with those who were not on neoadjuvant chemotherapy (P = .001). When thoracic surgery patients were excluded from the analysis, non-thoracic surgery patients who were on neoadjuvant chemotherapy had no increased incidence of postoperative pneumonia, compared with the patients who were not on neoadjuvant chemotherapy (P = .681). On multivariate analysis, significant variables associated with postoperative pneumonia were being on neoadjuvant chemotherapy (P= .001), having chronic obstructive pulmonary disease (P less than .0001), and having weight loss of greater than 10% (P = .004).

"Institutions with disproportionately busy complex thoracic surgery programs may have rates of postoperative pneumonia skewed higher than predicted by NSQIP models," Dr. Dexter concluded. "Optimization of nutritional status and COPD treatment in neoadjuvant chemotherapy patients may reduce postoperative pneumonia risk and incidence. Balance of oncologic benefit of neoadjuvant chemotherapy versus risk and morbidity of postoperative chemotherapy warrants future study in thoracic surgery patients."

Dr. Dexter said that she had no relevant financial conflicts to make.

[email protected]

SAN DIEGO – For thoracic surgery patients, being on neoadjuvant chemotherapy, having chronic obstructive pulmonary disease, and a weight loss of greater than 10% were all associated with the development of postoperative pneumonia, results from a single-center study showed.

At the national conference of the American College of Surgeons/National Surgical Quality Improvement Program, Dr. Elisabeth Dexter noted that after the first ACS/NSQIP data harvest at the Roswell Park Cancer Institute in Buffalo, N.Y., the risk of postoperative pneumonia was found to be 4.4%, compared with a rate of 1.1% in all other NSQIP hospitals.

"Of particular note, the thoracic surgery service had a high incidence of 13.2%," said Dr. Dexter, an attending surgeon in the department of thoracic surgery at the Institute. "The high incidence of our postoperative pneumonia was likely [affected] by our thoracic surgery service because our thoracic surgery service had an increased percentage of the abstracted NSQIP data in our cohort, from 12% to 14%, compared with other NSQIP hospitals of similar academic size abstracting 2%. When we found this high postoperative pneumonia rate, we decided to query our NSQIP data and our tumor registry between July 1, 2011, and Oct. 8, 2012, to ask the question: Is there an increased incidence of postoperative pneumonia in thoracic surgery patients who received neoadjuvant chemotherapy compared with those who did not?"

Dr. Dexter and her associates cross-referenced ACS/NSQIP data on 1,723 patients at the cancer center with the tumor registry. Of the 1,723 patients, 1,645 had no postoperative pneumonia while 78 did. Compared with the non-pneumonia patients, those who had pneumonia tended to be older (a mean of 67 vs. 60 years, respectively; odds ratio, 1.05; P less than .001), more likely to be male (59% vs. 37%; OR, 2.48; P less than .001), have chronic obstructive pulmonary disease (35% vs. 9%; OR, 5.08; P less than .001), be a smoker (36% vs. 24%; OR, 1.75; P = .021), and had lost more than 10% of body weight (10% vs. 2.5%; OR, 4.47; P less than .001).

On univariate analysis, postoperative pneumonia was associated with being on neoadjuvant chemotherapy (4.2% vs. 14%; OR, 3.75; P less than .001).

In addition, certain surgical subspecialties at the Institute had a high incidence of postoperative pneumonia, including thoracic surgery (46%), GI surgery (21%), and gynecology (12%).

When the researchers included the entire cohort of patients, those who were on neoadjuvant therapy had an increased incidence of postoperative pneumonia, compared with those who were not on neoadjuvant chemotherapy (P = .001). When thoracic surgery patients were excluded from the analysis, non-thoracic surgery patients who were on neoadjuvant chemotherapy had no increased incidence of postoperative pneumonia, compared with the patients who were not on neoadjuvant chemotherapy (P = .681). On multivariate analysis, significant variables associated with postoperative pneumonia were being on neoadjuvant chemotherapy (P= .001), having chronic obstructive pulmonary disease (P less than .0001), and having weight loss of greater than 10% (P = .004).

"Institutions with disproportionately busy complex thoracic surgery programs may have rates of postoperative pneumonia skewed higher than predicted by NSQIP models," Dr. Dexter concluded. "Optimization of nutritional status and COPD treatment in neoadjuvant chemotherapy patients may reduce postoperative pneumonia risk and incidence. Balance of oncologic benefit of neoadjuvant chemotherapy versus risk and morbidity of postoperative chemotherapy warrants future study in thoracic surgery patients."

Dr. Dexter said that she had no relevant financial conflicts to make.

[email protected]

SAN DIEGO – For thoracic surgery patients, being on neoadjuvant chemotherapy, having chronic obstructive pulmonary disease, and a weight loss of greater than 10% were all associated with the development of postoperative pneumonia, results from a single-center study showed.

At the national conference of the American College of Surgeons/National Surgical Quality Improvement Program, Dr. Elisabeth Dexter noted that after the first ACS/NSQIP data harvest at the Roswell Park Cancer Institute in Buffalo, N.Y., the risk of postoperative pneumonia was found to be 4.4%, compared with a rate of 1.1% in all other NSQIP hospitals.

"Of particular note, the thoracic surgery service had a high incidence of 13.2%," said Dr. Dexter, an attending surgeon in the department of thoracic surgery at the Institute. "The high incidence of our postoperative pneumonia was likely [affected] by our thoracic surgery service because our thoracic surgery service had an increased percentage of the abstracted NSQIP data in our cohort, from 12% to 14%, compared with other NSQIP hospitals of similar academic size abstracting 2%. When we found this high postoperative pneumonia rate, we decided to query our NSQIP data and our tumor registry between July 1, 2011, and Oct. 8, 2012, to ask the question: Is there an increased incidence of postoperative pneumonia in thoracic surgery patients who received neoadjuvant chemotherapy compared with those who did not?"

Dr. Dexter and her associates cross-referenced ACS/NSQIP data on 1,723 patients at the cancer center with the tumor registry. Of the 1,723 patients, 1,645 had no postoperative pneumonia while 78 did. Compared with the non-pneumonia patients, those who had pneumonia tended to be older (a mean of 67 vs. 60 years, respectively; odds ratio, 1.05; P less than .001), more likely to be male (59% vs. 37%; OR, 2.48; P less than .001), have chronic obstructive pulmonary disease (35% vs. 9%; OR, 5.08; P less than .001), be a smoker (36% vs. 24%; OR, 1.75; P = .021), and had lost more than 10% of body weight (10% vs. 2.5%; OR, 4.47; P less than .001).

On univariate analysis, postoperative pneumonia was associated with being on neoadjuvant chemotherapy (4.2% vs. 14%; OR, 3.75; P less than .001).

In addition, certain surgical subspecialties at the Institute had a high incidence of postoperative pneumonia, including thoracic surgery (46%), GI surgery (21%), and gynecology (12%).

When the researchers included the entire cohort of patients, those who were on neoadjuvant therapy had an increased incidence of postoperative pneumonia, compared with those who were not on neoadjuvant chemotherapy (P = .001). When thoracic surgery patients were excluded from the analysis, non-thoracic surgery patients who were on neoadjuvant chemotherapy had no increased incidence of postoperative pneumonia, compared with the patients who were not on neoadjuvant chemotherapy (P = .681). On multivariate analysis, significant variables associated with postoperative pneumonia were being on neoadjuvant chemotherapy (P= .001), having chronic obstructive pulmonary disease (P less than .0001), and having weight loss of greater than 10% (P = .004).

"Institutions with disproportionately busy complex thoracic surgery programs may have rates of postoperative pneumonia skewed higher than predicted by NSQIP models," Dr. Dexter concluded. "Optimization of nutritional status and COPD treatment in neoadjuvant chemotherapy patients may reduce postoperative pneumonia risk and incidence. Balance of oncologic benefit of neoadjuvant chemotherapy versus risk and morbidity of postoperative chemotherapy warrants future study in thoracic surgery patients."

Dr. Dexter said that she had no relevant financial conflicts to make.

[email protected]

SAN DIEGO – The implementation of an intensive preoperative screening and intervention process led to a significant decrease in 30-day mortality for general surgery and vascular procedures, results from a single-center study demonstrated.

In 2007, Carilion Roanoke (Va.) Memorial Hospital became a member of the American College of Surgeons/National Surgical Quality Improvement Program (ACS/NSQIP). "After receiving our first report, it became evident that surgical mortality at our institution was significantly higher than expected and significantly higher than the national average," Dr. Agathoklis Konstantinidis said at the ACS/NSQIP National Conference. "After further evaluation of this data, it became obvious that we were operating on people with several undiagnosed, untreated medical diseases such as diabetes, obstructive sleep apnea, hypertension, lung disease, and renal disease that all constituted significant preoperative risk factors."

In an effort to improve surgical mortality at the hospital, Dr. Konstantinidis and his associates implemented a strict preoperative screening and intervention program that began in January 2010. Since that time, every patient scheduled for surgery is required to undergo a preoperative screening appointment with a registered nurse who performs an extensive computer-based checklist of risk factors for heart disease, renal disease, abnormal EKG, sleep apnea, and pulmonary disease.

"If a problem is identified, the surgery is postponed until the issue is addressed, either by the primary care physician or by the surgeon who is directly involved in the care of the patient, and in close communication with other specialists, such as those in internal medicine, family practice, and endocrinology," explained Dr. Konstantinidis, who is a surgeon at the hospital.

Between July 2007 and December 2009 – prior to initiation of the preoperative screening and intervention program – the odds ratios for 30-day mortality in all cases were 1.40, 1.43, 1.58, and 1.56 in successive reporting periods. Beginning with the first report after implementation of the preoperative screening and intervention program, 30-day mortality in all cases progressively decreased in successive reporting periods (OR, 1.26, 1.19, 1.14, and 0.86, respectively), with similar reductions in both general surgery (OR, 0.92) and vascular surgery (OR, 0.92) for the last year.

"After the implementation of our new preoperative screening and intervention process, overall 30-day surgical mortality at our institution decreased from 3.5% to 1.9%, which is clinically and also statistically significant based on the P value (P = .007)," Dr. Konstantinidis said.

He went on to report that out of 5,866 patients who underwent screening in 2012 alone, 3,691 had undiagnosed obstructive sleep apnea, 2,361 had an abnormal preoperative EKG, 437 had undiagnosed diabetes, 192 had undiagnosed hypertension, and 167 had undiagnosed shortness of breath. "As a result of the screening intervention, surgery was canceled in 218 patients, and 147 were referred to cardiology specialists for further evaluation," he said.

Dr. Konstantinidis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – The implementation of an intensive preoperative screening and intervention process led to a significant decrease in 30-day mortality for general surgery and vascular procedures, results from a single-center study demonstrated.

In 2007, Carilion Roanoke (Va.) Memorial Hospital became a member of the American College of Surgeons/National Surgical Quality Improvement Program (ACS/NSQIP). "After receiving our first report, it became evident that surgical mortality at our institution was significantly higher than expected and significantly higher than the national average," Dr. Agathoklis Konstantinidis said at the ACS/NSQIP National Conference. "After further evaluation of this data, it became obvious that we were operating on people with several undiagnosed, untreated medical diseases such as diabetes, obstructive sleep apnea, hypertension, lung disease, and renal disease that all constituted significant preoperative risk factors."

In an effort to improve surgical mortality at the hospital, Dr. Konstantinidis and his associates implemented a strict preoperative screening and intervention program that began in January 2010. Since that time, every patient scheduled for surgery is required to undergo a preoperative screening appointment with a registered nurse who performs an extensive computer-based checklist of risk factors for heart disease, renal disease, abnormal EKG, sleep apnea, and pulmonary disease.

"If a problem is identified, the surgery is postponed until the issue is addressed, either by the primary care physician or by the surgeon who is directly involved in the care of the patient, and in close communication with other specialists, such as those in internal medicine, family practice, and endocrinology," explained Dr. Konstantinidis, who is a surgeon at the hospital.

Between July 2007 and December 2009 – prior to initiation of the preoperative screening and intervention program – the odds ratios for 30-day mortality in all cases were 1.40, 1.43, 1.58, and 1.56 in successive reporting periods. Beginning with the first report after implementation of the preoperative screening and intervention program, 30-day mortality in all cases progressively decreased in successive reporting periods (OR, 1.26, 1.19, 1.14, and 0.86, respectively), with similar reductions in both general surgery (OR, 0.92) and vascular surgery (OR, 0.92) for the last year.

"After the implementation of our new preoperative screening and intervention process, overall 30-day surgical mortality at our institution decreased from 3.5% to 1.9%, which is clinically and also statistically significant based on the P value (P = .007)," Dr. Konstantinidis said.

He went on to report that out of 5,866 patients who underwent screening in 2012 alone, 3,691 had undiagnosed obstructive sleep apnea, 2,361 had an abnormal preoperative EKG, 437 had undiagnosed diabetes, 192 had undiagnosed hypertension, and 167 had undiagnosed shortness of breath. "As a result of the screening intervention, surgery was canceled in 218 patients, and 147 were referred to cardiology specialists for further evaluation," he said.

Dr. Konstantinidis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – The implementation of an intensive preoperative screening and intervention process led to a significant decrease in 30-day mortality for general surgery and vascular procedures, results from a single-center study demonstrated.

In 2007, Carilion Roanoke (Va.) Memorial Hospital became a member of the American College of Surgeons/National Surgical Quality Improvement Program (ACS/NSQIP). "After receiving our first report, it became evident that surgical mortality at our institution was significantly higher than expected and significantly higher than the national average," Dr. Agathoklis Konstantinidis said at the ACS/NSQIP National Conference. "After further evaluation of this data, it became obvious that we were operating on people with several undiagnosed, untreated medical diseases such as diabetes, obstructive sleep apnea, hypertension, lung disease, and renal disease that all constituted significant preoperative risk factors."

In an effort to improve surgical mortality at the hospital, Dr. Konstantinidis and his associates implemented a strict preoperative screening and intervention program that began in January 2010. Since that time, every patient scheduled for surgery is required to undergo a preoperative screening appointment with a registered nurse who performs an extensive computer-based checklist of risk factors for heart disease, renal disease, abnormal EKG, sleep apnea, and pulmonary disease.

"If a problem is identified, the surgery is postponed until the issue is addressed, either by the primary care physician or by the surgeon who is directly involved in the care of the patient, and in close communication with other specialists, such as those in internal medicine, family practice, and endocrinology," explained Dr. Konstantinidis, who is a surgeon at the hospital.

Between July 2007 and December 2009 – prior to initiation of the preoperative screening and intervention program – the odds ratios for 30-day mortality in all cases were 1.40, 1.43, 1.58, and 1.56 in successive reporting periods. Beginning with the first report after implementation of the preoperative screening and intervention program, 30-day mortality in all cases progressively decreased in successive reporting periods (OR, 1.26, 1.19, 1.14, and 0.86, respectively), with similar reductions in both general surgery (OR, 0.92) and vascular surgery (OR, 0.92) for the last year.

"After the implementation of our new preoperative screening and intervention process, overall 30-day surgical mortality at our institution decreased from 3.5% to 1.9%, which is clinically and also statistically significant based on the P value (P = .007)," Dr. Konstantinidis said.

He went on to report that out of 5,866 patients who underwent screening in 2012 alone, 3,691 had undiagnosed obstructive sleep apnea, 2,361 had an abnormal preoperative EKG, 437 had undiagnosed diabetes, 192 had undiagnosed hypertension, and 167 had undiagnosed shortness of breath. "As a result of the screening intervention, surgery was canceled in 218 patients, and 147 were referred to cardiology specialists for further evaluation," he said.

Dr. Konstantinidis said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Transvaginal ultrasound is accurate, sensitive, and specific in the diagnosis of leiomyoma and coexisting adenomyosis and leiomyoma, results from a single-center study showed.

"Menorrhagia is a very common condition which female patients are suffering from many days of the month," Dr. Magdi Hanafi, FACS, said in an interview after the American College of Surgeons/National Surgical Quality Improvement Program National Conference, where the study was presented at a poster session.

"It interferes with their normal day-to-day life and work, and causes anemia and its subsequent complications. Two of the common causes of menorrhagia are adenomyosis and leiomyoma. These two conditions are frequently missed by some gynecologists – especially adenomyosis – clinically and on some occasions by pelvic ultrasound."

Dr. Hanafi, medical director of Gyn. and Fertility Specialists at Saint Joseph’s Hospital of Atlanta, retrospectively evaluated 163 women with a preoperative transvaginal ultrasound (TVS) diagnosis of adenomyosis, leiomyoma, and adenomyosis with coexisting leiomyoma. Of the 163 patients, 130 underwent hysterectomy and 33 symptomatic patients underwent myomectomy with excision of the surrounding myometrium, which presumably contained adenomyosis. Following surgery, hospital pathologists performed a histological examination and recorded the diagnosis.

The mean age of the patients was 44 years. Dr. Hanafi reported that 123 of the patients were positively diagnosed with adenomyosis via TVS. Among these, histopathologic confirmation of TVS diagnosis of adenomyosis was positive in 93 patients (76%) and negative in 30 (24%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of adenomyosis were 85% (P less than .0001), 43% (P = .41), and 71%, respectively. "This demonstrates that TVS diagnosis of adenomyosis is sensitive, but not specific," he said.

Histopathologic data on leiomyoma was complete in 134 of the patients. Among these, histopathologic confirmation of TVS diagnosis of leiomyoma was positive in 133 patients (99%) and negative in 1 (1%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of leiomyoma were 96% (P less than .0001), 96% (P less than .0001), and 96%, respectively.

"In other published studies in the diagnosis of adenomyosis, combined adenomyosis and leiomyoma was not mentioned," Dr. Hanafi commented. "This combination is more common than we ever thought before, and all gynecologists should think of this combined condition in menorrhagic patients in their differential diagnosis."

He concluded that office TVS "is a very valuable procedure in the diagnosis of adenomyosis, leiomyoma, or combined [adenomyosis and leiomyoma]. It is sensitive and accurate in the diagnosis of leiomyoma, adenomyosis, or [the combination], but not specific in the diagnosis of adenomyosis alone."

Dr. Hanafi said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Transvaginal ultrasound is accurate, sensitive, and specific in the diagnosis of leiomyoma and coexisting adenomyosis and leiomyoma, results from a single-center study showed.

"Menorrhagia is a very common condition which female patients are suffering from many days of the month," Dr. Magdi Hanafi, FACS, said in an interview after the American College of Surgeons/National Surgical Quality Improvement Program National Conference, where the study was presented at a poster session.

"It interferes with their normal day-to-day life and work, and causes anemia and its subsequent complications. Two of the common causes of menorrhagia are adenomyosis and leiomyoma. These two conditions are frequently missed by some gynecologists – especially adenomyosis – clinically and on some occasions by pelvic ultrasound."

Dr. Hanafi, medical director of Gyn. and Fertility Specialists at Saint Joseph’s Hospital of Atlanta, retrospectively evaluated 163 women with a preoperative transvaginal ultrasound (TVS) diagnosis of adenomyosis, leiomyoma, and adenomyosis with coexisting leiomyoma. Of the 163 patients, 130 underwent hysterectomy and 33 symptomatic patients underwent myomectomy with excision of the surrounding myometrium, which presumably contained adenomyosis. Following surgery, hospital pathologists performed a histological examination and recorded the diagnosis.

The mean age of the patients was 44 years. Dr. Hanafi reported that 123 of the patients were positively diagnosed with adenomyosis via TVS. Among these, histopathologic confirmation of TVS diagnosis of adenomyosis was positive in 93 patients (76%) and negative in 30 (24%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of adenomyosis were 85% (P less than .0001), 43% (P = .41), and 71%, respectively. "This demonstrates that TVS diagnosis of adenomyosis is sensitive, but not specific," he said.

Histopathologic data on leiomyoma was complete in 134 of the patients. Among these, histopathologic confirmation of TVS diagnosis of leiomyoma was positive in 133 patients (99%) and negative in 1 (1%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of leiomyoma were 96% (P less than .0001), 96% (P less than .0001), and 96%, respectively.

"In other published studies in the diagnosis of adenomyosis, combined adenomyosis and leiomyoma was not mentioned," Dr. Hanafi commented. "This combination is more common than we ever thought before, and all gynecologists should think of this combined condition in menorrhagic patients in their differential diagnosis."

He concluded that office TVS "is a very valuable procedure in the diagnosis of adenomyosis, leiomyoma, or combined [adenomyosis and leiomyoma]. It is sensitive and accurate in the diagnosis of leiomyoma, adenomyosis, or [the combination], but not specific in the diagnosis of adenomyosis alone."

Dr. Hanafi said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Transvaginal ultrasound is accurate, sensitive, and specific in the diagnosis of leiomyoma and coexisting adenomyosis and leiomyoma, results from a single-center study showed.

"Menorrhagia is a very common condition which female patients are suffering from many days of the month," Dr. Magdi Hanafi, FACS, said in an interview after the American College of Surgeons/National Surgical Quality Improvement Program National Conference, where the study was presented at a poster session.

"It interferes with their normal day-to-day life and work, and causes anemia and its subsequent complications. Two of the common causes of menorrhagia are adenomyosis and leiomyoma. These two conditions are frequently missed by some gynecologists – especially adenomyosis – clinically and on some occasions by pelvic ultrasound."

Dr. Hanafi, medical director of Gyn. and Fertility Specialists at Saint Joseph’s Hospital of Atlanta, retrospectively evaluated 163 women with a preoperative transvaginal ultrasound (TVS) diagnosis of adenomyosis, leiomyoma, and adenomyosis with coexisting leiomyoma. Of the 163 patients, 130 underwent hysterectomy and 33 symptomatic patients underwent myomectomy with excision of the surrounding myometrium, which presumably contained adenomyosis. Following surgery, hospital pathologists performed a histological examination and recorded the diagnosis.

The mean age of the patients was 44 years. Dr. Hanafi reported that 123 of the patients were positively diagnosed with adenomyosis via TVS. Among these, histopathologic confirmation of TVS diagnosis of adenomyosis was positive in 93 patients (76%) and negative in 30 (24%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of adenomyosis were 85% (P less than .0001), 43% (P = .41), and 71%, respectively. "This demonstrates that TVS diagnosis of adenomyosis is sensitive, but not specific," he said.

Histopathologic data on leiomyoma was complete in 134 of the patients. Among these, histopathologic confirmation of TVS diagnosis of leiomyoma was positive in 133 patients (99%) and negative in 1 (1%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of leiomyoma were 96% (P less than .0001), 96% (P less than .0001), and 96%, respectively.

"In other published studies in the diagnosis of adenomyosis, combined adenomyosis and leiomyoma was not mentioned," Dr. Hanafi commented. "This combination is more common than we ever thought before, and all gynecologists should think of this combined condition in menorrhagic patients in their differential diagnosis."

He concluded that office TVS "is a very valuable procedure in the diagnosis of adenomyosis, leiomyoma, or combined [adenomyosis and leiomyoma]. It is sensitive and accurate in the diagnosis of leiomyoma, adenomyosis, or [the combination], but not specific in the diagnosis of adenomyosis alone."

Dr. Hanafi said that he had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – Patients who underwent adhesiolysis within 24 hours of hospital admission for acute small bowel obstruction had a significant reduction in 30-day major morbidity, mortality, and hospital length of stay, compared with those who underwent adhesiolysis after 24 hours, results from an analysis of national data showed.

"Historically, the teaching was that surgeons should never let the sun rise and set on a complete small bowel obstruction," Dr. Kristin N. Kelly said at the national conference of the American College of Surgeons/National Surgical Quality Improvement Program. "The consequences of bowel ischemia, perforation, and peritonitis were feared. Interestingly, over the past 2 decades, practice patterns have shifted."

For example, she said, a recent study of data from the 2009 Nationwide Inpatient Sample researchers found that only 18% of patients with small bowel obstruction received surgical intervention and the rest were managed with conservative measures including intravenous fluid and nasogastric decompression (J. Trauma Acute Care Surg. 2013;74:181-7).

In addition, recently released guidelines (World J. Emerg. Surg. 2011;6:5) "have suggested that without peritoneal signs or evidence of bowel ischemia, nonoperative management can be extended for 3-5 days before contrast studies or surgery [is] recommended," said Dr. Kelly of the Surgical Health Outcomes and Research Enterprise (SHORE) and the department of surgery at the University of Rochester (N.Y.) Medical Center. "The concern remains that surgery may be difficult or dangerous or promote additional adhesion formation. Alternatively, delaying surgical treatment may increase morbidity and mortality. We wondered if perhaps we’ve moved too far toward conservative management. We sought to address if there is a benefit to a prompt surgical approach. Our aim was to examine whether adhesiolysis within 24 hours of admission for acute small bowel obstruction is associated with improved 30-day morbidity and mortality compared with those undergoing later adhesiolysis."

She and her associates searched the 2005-2010 American College of Surgeons/National Surgical Quality Improvement Program database for patients who had a diagnosis of adhesive small bowel obstruction. They limited their analysis to patients who were operated on within 1 week of admission. The time from admission to operation was classified as early (within 24 hours) or late (after 24 hours). The groups were compared using univariate and multivariate analysis to examine the association between numerous patient and operative factors.

Of the 8,912 patients who met inclusion criteria, 3,240 (36%) underwent early adhesiolysis while the remaining 5,692 (64%) underwent the procedure late. The mean time to surgery was 1.7 days, while about three-quarters of patients in the late group had surgery between 1 and 3 days after admission.

Compared with patients in the late adhesiolysis group, those in the early adhesiolysis group had higher rates of emergency operations (60% vs. 45%, respectively; P less than .0001), and more laparoscopic operations (19% vs. 13%; P less than .0001), but both groups had similar operative times (a mean of 93 vs. 89 minutes) and similar rates of small bowel resection (27% vs. 28%). The mean postoperative length of stay was about 2 days shorter in the early group (7.4 days vs. 9.5 days; P less than .0001).

"Patients in the early group were slightly younger, had fewer comorbodities, and better functional status," Dr. Kelly added. "But the rates of preoperative sepsis and systemic inflammatory response syndrome were similar."

On multivariate analysis patients in the early adhesiolysis group had 17% fewer major complications (odds ratio, 0.83; P = .005) and a 26% lower mortality rate (OR, 0.74; P = .041) at 30 days, compared with their counterparts in the late adhesiolysis group. The three most common complications were respiratory complications (28%), sepsis/septic shock (25%), and unexpected return to the operating room (18%).

Dr. Kelly acknowledged certain limitations of the study, including the potential for selection bias and that "perhaps surgeons postpone operating on patients with many comorbodities and poorer functional status, or perhaps it takes several days for a surgical referral," she said. "We are also limited because we do not have information regarding all of the clinical, personal, and administrative factors that may go into any individual surgeon’s decision to take a patient to the OR. Finally, we don’t have data on the case difficulty or any intraoperative occurrences. These would be useful in evaluating whether the timing really affected how challenging the case might be." Nevertheless, the findings "support early surgeon involvement and an expeditious approach to small bowel obstruction," she concluded.

Dr. Kelly said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – Patients who underwent adhesiolysis within 24 hours of hospital admission for acute small bowel obstruction had a significant reduction in 30-day major morbidity, mortality, and hospital length of stay, compared with those who underwent adhesiolysis after 24 hours, results from an analysis of national data showed.

"Historically, the teaching was that surgeons should never let the sun rise and set on a complete small bowel obstruction," Dr. Kristin N. Kelly said at the national conference of the American College of Surgeons/National Surgical Quality Improvement Program. "The consequences of bowel ischemia, perforation, and peritonitis were feared. Interestingly, over the past 2 decades, practice patterns have shifted."

For example, she said, a recent study of data from the 2009 Nationwide Inpatient Sample researchers found that only 18% of patients with small bowel obstruction received surgical intervention and the rest were managed with conservative measures including intravenous fluid and nasogastric decompression (J. Trauma Acute Care Surg. 2013;74:181-7).

In addition, recently released guidelines (World J. Emerg. Surg. 2011;6:5) "have suggested that without peritoneal signs or evidence of bowel ischemia, nonoperative management can be extended for 3-5 days before contrast studies or surgery [is] recommended," said Dr. Kelly of the Surgical Health Outcomes and Research Enterprise (SHORE) and the department of surgery at the University of Rochester (N.Y.) Medical Center. "The concern remains that surgery may be difficult or dangerous or promote additional adhesion formation. Alternatively, delaying surgical treatment may increase morbidity and mortality. We wondered if perhaps we’ve moved too far toward conservative management. We sought to address if there is a benefit to a prompt surgical approach. Our aim was to examine whether adhesiolysis within 24 hours of admission for acute small bowel obstruction is associated with improved 30-day morbidity and mortality compared with those undergoing later adhesiolysis."

She and her associates searched the 2005-2010 American College of Surgeons/National Surgical Quality Improvement Program database for patients who had a diagnosis of adhesive small bowel obstruction. They limited their analysis to patients who were operated on within 1 week of admission. The time from admission to operation was classified as early (within 24 hours) or late (after 24 hours). The groups were compared using univariate and multivariate analysis to examine the association between numerous patient and operative factors.

Of the 8,912 patients who met inclusion criteria, 3,240 (36%) underwent early adhesiolysis while the remaining 5,692 (64%) underwent the procedure late. The mean time to surgery was 1.7 days, while about three-quarters of patients in the late group had surgery between 1 and 3 days after admission.

Compared with patients in the late adhesiolysis group, those in the early adhesiolysis group had higher rates of emergency operations (60% vs. 45%, respectively; P less than .0001), and more laparoscopic operations (19% vs. 13%; P less than .0001), but both groups had similar operative times (a mean of 93 vs. 89 minutes) and similar rates of small bowel resection (27% vs. 28%). The mean postoperative length of stay was about 2 days shorter in the early group (7.4 days vs. 9.5 days; P less than .0001).

"Patients in the early group were slightly younger, had fewer comorbodities, and better functional status," Dr. Kelly added. "But the rates of preoperative sepsis and systemic inflammatory response syndrome were similar."

On multivariate analysis patients in the early adhesiolysis group had 17% fewer major complications (odds ratio, 0.83; P = .005) and a 26% lower mortality rate (OR, 0.74; P = .041) at 30 days, compared with their counterparts in the late adhesiolysis group. The three most common complications were respiratory complications (28%), sepsis/septic shock (25%), and unexpected return to the operating room (18%).

Dr. Kelly acknowledged certain limitations of the study, including the potential for selection bias and that "perhaps surgeons postpone operating on patients with many comorbodities and poorer functional status, or perhaps it takes several days for a surgical referral," she said. "We are also limited because we do not have information regarding all of the clinical, personal, and administrative factors that may go into any individual surgeon’s decision to take a patient to the OR. Finally, we don’t have data on the case difficulty or any intraoperative occurrences. These would be useful in evaluating whether the timing really affected how challenging the case might be." Nevertheless, the findings "support early surgeon involvement and an expeditious approach to small bowel obstruction," she concluded.

Dr. Kelly said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – Patients who underwent adhesiolysis within 24 hours of hospital admission for acute small bowel obstruction had a significant reduction in 30-day major morbidity, mortality, and hospital length of stay, compared with those who underwent adhesiolysis after 24 hours, results from an analysis of national data showed.

"Historically, the teaching was that surgeons should never let the sun rise and set on a complete small bowel obstruction," Dr. Kristin N. Kelly said at the national conference of the American College of Surgeons/National Surgical Quality Improvement Program. "The consequences of bowel ischemia, perforation, and peritonitis were feared. Interestingly, over the past 2 decades, practice patterns have shifted."

For example, she said, a recent study of data from the 2009 Nationwide Inpatient Sample researchers found that only 18% of patients with small bowel obstruction received surgical intervention and the rest were managed with conservative measures including intravenous fluid and nasogastric decompression (J. Trauma Acute Care Surg. 2013;74:181-7).

In addition, recently released guidelines (World J. Emerg. Surg. 2011;6:5) "have suggested that without peritoneal signs or evidence of bowel ischemia, nonoperative management can be extended for 3-5 days before contrast studies or surgery [is] recommended," said Dr. Kelly of the Surgical Health Outcomes and Research Enterprise (SHORE) and the department of surgery at the University of Rochester (N.Y.) Medical Center. "The concern remains that surgery may be difficult or dangerous or promote additional adhesion formation. Alternatively, delaying surgical treatment may increase morbidity and mortality. We wondered if perhaps we’ve moved too far toward conservative management. We sought to address if there is a benefit to a prompt surgical approach. Our aim was to examine whether adhesiolysis within 24 hours of admission for acute small bowel obstruction is associated with improved 30-day morbidity and mortality compared with those undergoing later adhesiolysis."

She and her associates searched the 2005-2010 American College of Surgeons/National Surgical Quality Improvement Program database for patients who had a diagnosis of adhesive small bowel obstruction. They limited their analysis to patients who were operated on within 1 week of admission. The time from admission to operation was classified as early (within 24 hours) or late (after 24 hours). The groups were compared using univariate and multivariate analysis to examine the association between numerous patient and operative factors.

Of the 8,912 patients who met inclusion criteria, 3,240 (36%) underwent early adhesiolysis while the remaining 5,692 (64%) underwent the procedure late. The mean time to surgery was 1.7 days, while about three-quarters of patients in the late group had surgery between 1 and 3 days after admission.

Compared with patients in the late adhesiolysis group, those in the early adhesiolysis group had higher rates of emergency operations (60% vs. 45%, respectively; P less than .0001), and more laparoscopic operations (19% vs. 13%; P less than .0001), but both groups had similar operative times (a mean of 93 vs. 89 minutes) and similar rates of small bowel resection (27% vs. 28%). The mean postoperative length of stay was about 2 days shorter in the early group (7.4 days vs. 9.5 days; P less than .0001).

"Patients in the early group were slightly younger, had fewer comorbodities, and better functional status," Dr. Kelly added. "But the rates of preoperative sepsis and systemic inflammatory response syndrome were similar."

On multivariate analysis patients in the early adhesiolysis group had 17% fewer major complications (odds ratio, 0.83; P = .005) and a 26% lower mortality rate (OR, 0.74; P = .041) at 30 days, compared with their counterparts in the late adhesiolysis group. The three most common complications were respiratory complications (28%), sepsis/septic shock (25%), and unexpected return to the operating room (18%).

Dr. Kelly acknowledged certain limitations of the study, including the potential for selection bias and that "perhaps surgeons postpone operating on patients with many comorbodities and poorer functional status, or perhaps it takes several days for a surgical referral," she said. "We are also limited because we do not have information regarding all of the clinical, personal, and administrative factors that may go into any individual surgeon’s decision to take a patient to the OR. Finally, we don’t have data on the case difficulty or any intraoperative occurrences. These would be useful in evaluating whether the timing really affected how challenging the case might be." Nevertheless, the findings "support early surgeon involvement and an expeditious approach to small bowel obstruction," she concluded.

Dr. Kelly said she had no relevant financial disclosures.

[email protected]

SAN DIEGO – Patients who undergo dialysis before cholecystectomy face a significantly higher risk for postoperative morbidity but not mortality, results from a large analysis of national data showed.

"We hope that these data will allow surgeons to quantitate the risks that are associated with operating on these patients and help them to relay that information to their patients preoperatively," Sophia F. Tam said at the American College of Surgeons/National Surgical Quality Improvement Program National Conference. "We also would like to further study why these adverse outcomes are occurring, and any preoperative or preventive measures that we can make in order to avoid these adverse outcomes."

Although cholecystectomy is one of the most commonly performed surgical procedures in the United States, there is a lack of quantitative data on the postoperative risks of the procedure in patients who are undergoing dialysis, said Ms. Tam, a third-year medical student at the State University of New York Downstate Medical Center, Brooklyn.

To examine postoperative outcomes following cholecystectomy in dialysis patients, she and her associates evaluated data from the public use file of the American College of Surgeons National Surgical Quality Improvement Program. The sample included 93,703 patients aged 16 or older who underwent cholecystectomy identified by CPT codes during 2006-2010. Of these, 551 were on chronic dialysis. The researchers used ICD-9 codes to exclude cases caused by trauma and selected a matched control group of 530 nondialysis patients based on age, sex, and surgical approach. Outcomes of interest were morbidity, mortality, and hospital length of stay.

Morbidity was defined as having one or more of the following after cholecystectomy: wound infection, wound disruption, pneumonia, unplanned intubation, pulmonary embolism, being on a ventilator for more than 48 hours, cardiac arrest, myocardial infarction, bleeding requiring transfusion, deep vein thrombosis, sepsis, septic shock, and unplanned return to the operating room.

With univariate analysis, the researchers found that in comparison with nondialysis patients, dialysis patients had higher rates of at least one morbidity (14% vs. 3.6%, respectively), mortality (4.2% vs. 0.3%), and mean hospital length of stay (4.3 vs. 1.2 days). All differences were statistically significant with a P value of less than.0001. Compared with nondialysis patients, dialysis patients had higher rates of infectious, pulmonary, and cardiovascular complications, as well as returns to the OR (all significant with a P value of less than .05).

With multivariate logistic regression adjusted for confounding variables, dialysis patients were more likely than were nondialysis patients to experience at least one morbidity (13.8% vs. 4.7%; adjusted odds ratio 2.3), but there was no difference in mortality between the two groups. Hospital length of stay continued to be significantly higher among dialysis patients, compared with their nondialysis counterparts (a mean of 4.3 vs. 1.4 days; adjusted OR 2.0).

Ms. Tam had no disclosures.

[email protected]

SAN DIEGO – Patients who undergo dialysis before cholecystectomy face a significantly higher risk for postoperative morbidity but not mortality, results from a large analysis of national data showed.

"We hope that these data will allow surgeons to quantitate the risks that are associated with operating on these patients and help them to relay that information to their patients preoperatively," Sophia F. Tam said at the American College of Surgeons/National Surgical Quality Improvement Program National Conference. "We also would like to further study why these adverse outcomes are occurring, and any preoperative or preventive measures that we can make in order to avoid these adverse outcomes."

Although cholecystectomy is one of the most commonly performed surgical procedures in the United States, there is a lack of quantitative data on the postoperative risks of the procedure in patients who are undergoing dialysis, said Ms. Tam, a third-year medical student at the State University of New York Downstate Medical Center, Brooklyn.

To examine postoperative outcomes following cholecystectomy in dialysis patients, she and her associates evaluated data from the public use file of the American College of Surgeons National Surgical Quality Improvement Program. The sample included 93,703 patients aged 16 or older who underwent cholecystectomy identified by CPT codes during 2006-2010. Of these, 551 were on chronic dialysis. The researchers used ICD-9 codes to exclude cases caused by trauma and selected a matched control group of 530 nondialysis patients based on age, sex, and surgical approach. Outcomes of interest were morbidity, mortality, and hospital length of stay.

Morbidity was defined as having one or more of the following after cholecystectomy: wound infection, wound disruption, pneumonia, unplanned intubation, pulmonary embolism, being on a ventilator for more than 48 hours, cardiac arrest, myocardial infarction, bleeding requiring transfusion, deep vein thrombosis, sepsis, septic shock, and unplanned return to the operating room.

With univariate analysis, the researchers found that in comparison with nondialysis patients, dialysis patients had higher rates of at least one morbidity (14% vs. 3.6%, respectively), mortality (4.2% vs. 0.3%), and mean hospital length of stay (4.3 vs. 1.2 days). All differences were statistically significant with a P value of less than.0001. Compared with nondialysis patients, dialysis patients had higher rates of infectious, pulmonary, and cardiovascular complications, as well as returns to the OR (all significant with a P value of less than .05).

With multivariate logistic regression adjusted for confounding variables, dialysis patients were more likely than were nondialysis patients to experience at least one morbidity (13.8% vs. 4.7%; adjusted odds ratio 2.3), but there was no difference in mortality between the two groups. Hospital length of stay continued to be significantly higher among dialysis patients, compared with their nondialysis counterparts (a mean of 4.3 vs. 1.4 days; adjusted OR 2.0).

Ms. Tam had no disclosures.

[email protected]

SAN DIEGO – Patients who undergo dialysis before cholecystectomy face a significantly higher risk for postoperative morbidity but not mortality, results from a large analysis of national data showed.

"We hope that these data will allow surgeons to quantitate the risks that are associated with operating on these patients and help them to relay that information to their patients preoperatively," Sophia F. Tam said at the American College of Surgeons/National Surgical Quality Improvement Program National Conference. "We also would like to further study why these adverse outcomes are occurring, and any preoperative or preventive measures that we can make in order to avoid these adverse outcomes."

Although cholecystectomy is one of the most commonly performed surgical procedures in the United States, there is a lack of quantitative data on the postoperative risks of the procedure in patients who are undergoing dialysis, said Ms. Tam, a third-year medical student at the State University of New York Downstate Medical Center, Brooklyn.

To examine postoperative outcomes following cholecystectomy in dialysis patients, she and her associates evaluated data from the public use file of the American College of Surgeons National Surgical Quality Improvement Program. The sample included 93,703 patients aged 16 or older who underwent cholecystectomy identified by CPT codes during 2006-2010. Of these, 551 were on chronic dialysis. The researchers used ICD-9 codes to exclude cases caused by trauma and selected a matched control group of 530 nondialysis patients based on age, sex, and surgical approach. Outcomes of interest were morbidity, mortality, and hospital length of stay.

Morbidity was defined as having one or more of the following after cholecystectomy: wound infection, wound disruption, pneumonia, unplanned intubation, pulmonary embolism, being on a ventilator for more than 48 hours, cardiac arrest, myocardial infarction, bleeding requiring transfusion, deep vein thrombosis, sepsis, septic shock, and unplanned return to the operating room.

With univariate analysis, the researchers found that in comparison with nondialysis patients, dialysis patients had higher rates of at least one morbidity (14% vs. 3.6%, respectively), mortality (4.2% vs. 0.3%), and mean hospital length of stay (4.3 vs. 1.2 days). All differences were statistically significant with a P value of less than.0001. Compared with nondialysis patients, dialysis patients had higher rates of infectious, pulmonary, and cardiovascular complications, as well as returns to the OR (all significant with a P value of less than .05).

With multivariate logistic regression adjusted for confounding variables, dialysis patients were more likely than were nondialysis patients to experience at least one morbidity (13.8% vs. 4.7%; adjusted odds ratio 2.3), but there was no difference in mortality between the two groups. Hospital length of stay continued to be significantly higher among dialysis patients, compared with their nondialysis counterparts (a mean of 4.3 vs. 1.4 days; adjusted OR 2.0).

Ms. Tam had no disclosures.

[email protected]