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Impact of hepatectomy surgical complexity on outcomes and hospital quality rankings.

Abstract：

BACKGROUND:There is substantial variation in the surgical complexity of hepatectomy. Currently, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk adjusts for hospital quality comparisons using only the primary procedure code. Our objectives were to (1) assess the association between secondary procedures and complications; (2) assess model performance with inclusion of surgical complexity adjustment; and (3) examine whether secondary procedures affect hospital quality rankings. METHODS:Using ACS NSQIP (2007-2012), patients undergoing hepatectomy were identified. Secondary procedure codes and total work relative value units (RVUs) were used to approximate procedural complexity. The effect of procedural complexity variables on outcomes and hospital quality rankings were examined using hierarchical models. RESULTS:Among 11,826 patients who underwent hepatectomy at 261 hospitals, 32.8 % underwent at least one secondary procedure. Serious morbidity occurred in 18.0 % of patients. Seven of nine secondary procedures were significantly associated with death or serious morbidity on multivariable analysis. Model performance improved when secondary procedure categories were included, and secondary procedure categories outperformed total RVUs. The C-statistic for death or serious morbidity was 0.689 in the standard NSQIP model, 0.703 when total RVU was included, and 0.718 when secondary procedure categories were included. Of the 26 hospitals that were poor performers for death or serious morbidity using the standard ACS NSQIP model, three became average performers when secondary procedure categories were included in the model. CONCLUSIONS:Secondary procedures are associated with an increased risk of postoperative complications. Inclusion of secondary procedure code categories in research and risk prediction models should be considered for hepatectomy.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Paruch JL,Merkow RP,Bentrem DJ,Ko CY,Posner MC,Cohen ME,Bilimoria KY,Weber SM

doi

10.1245/s10434-014-3500-5

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

1773-80

issue

eissn

1068-9265

issn

1534-4681

journal_volume

pub_type

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Impact of hepatectomy surgical complexity on outcomes and hospital quality rankings.