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Am J Surg. 2015 Feb;209(2):219-29. doi: 10.1016/j.amjsurg.2014.08.020. Epub 2014 Oct 13.

Patient-specific risk factors are predictive for postoperative adverse events in colorectal surgery: an American College of Surgeons National Surgical Quality Improvement Program-based analysis.

Author information

1
Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine, 245 North 15th Street, MS 413, Philadelphia, PA 19102-1192, USA.
2
Division of Colorectal Surgery, Department of Surgery, Drexel University College of Medicine, 245 North 15th Street, MS 413, Philadelphia, PA 19102-1192, USA. Electronic address: Juan.Poggio@DrexelMed.edu.

Abstract

BACKGROUND:

Pay-for-performance measures incorporate surgical site infection rates into reimbursement algorithms without accounting for patient-specific risk factors predictive for surgical site infections and other adverse postoperative outcomes.

METHODS:

Using American College of Surgeons National Surgical Quality Improvement Program data of 67,445 colorectal patients, multivariable logistic regression was performed to determine independent risk factors associated with various measures of adverse postoperative outcomes.

RESULTS:

Notable patient-specific factors included (number of models containing predictor variable; range of odds ratios [ORs] from all models): American Society of Anesthesiologists class 3, 4, or 5 (7 of 7 models; OR 1.25 to 1.74), open procedures (7 of 7 models; OR .51 to 4.37), increased body mass index (6 of 7 models; OR 1.15 to 2.19), history of COPD (6 of 7 models; OR 1.19 to 1.64), smoking (6 of 7 models; OR 1.15 to 1.61), wound class 3 or 4 (6 of 7 models; OR 1.22 to 1.56), sepsis (6 of 7 models; OR 1.14 to 1.89), corticosteroid administration (5 of 7 models; OR 1.11 to 2.24), and operation duration more than 3 hours (5 of 7 models; OR 1.41 to 1.76).

CONCLUSIONS:

These findings may be used to pre-emptively identify colorectal surgery patients at increased risk of experiencing adverse outcomes.

KEYWORDS:

ACS NSQIP; Colorectal resection; Colorectal surgery; Pay for performance; Postoperative complications; Surgical site infection

PMID:
25457238
DOI:
10.1016/j.amjsurg.2014.08.020
[Indexed for MEDLINE]

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