Abstract
Background Most risk adjustment approaches adjust for patient comorbidities and the primary procedure. However, procedures done at the same time as the index case may increase operative risk and merit inclusion in adjustment models for fair hospital comparisons. Our objectives were to evaluate the impact of surgical complexity on postoperative outcomes and hospital comparisons in gastric cancer surgery. Methods Patients who underwent gastric resection for cancer were identified from a large clinical dataset. Procedure complexity was characterized using secondary procedure CPT codes and work relative value units (RVUs). Regression models were developed to evaluate the association between complexity variables and outcomes. The impact of complexity adjustment on model performance and hospital comparisons was examined. Results Among 3,467 patients who underwent gastrectomy for adenocarcinoma, 2,171 operations were distal and 1,296 total. A secondary procedure was reported for 33% of distal gastrectomies and 59% of total gastrectomies. Six of 10 secondary procedures were associated with adverse outcomes. For example, patients who underwent a synchronous bowel resection had a higher risk of mortality (odds ratio [OR], 2.14; 95% CI, 1.07-4.29) and reoperation (OR, 2.09; 95% CI, 1.26-3.47). Model performance was slightly better for nearly all outcomes with complexity adjustment (mortality c-statistics: standard model, 0.853; secondary procedure model, 0.858; RVU model, 0.855). Hospital ranking did not change substantially after complexity adjustment. Conclusion Surgical complexity variables are associated with adverse outcomes in gastrectomy, but complexity adjustment does not affect hospital rankings appreciably.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 522-528 |
| Number of pages | 7 |
| Journal | Surgery (United States) |
| Volume | 158 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 1 2015 |
Funding
In patients undergoing gastrectomy for gastric adenocarcinoma, some synchronous secondary procedures are associated with worsened outcome and warrant inclusion in consent discussions between surgeons and patients. However, complexity adjustment did not result in appreciable differences in model performance or hospital rankings. This work was supported in part by the American Cancer Society . Dr Mohanty is supported by the American College of Surgeons Clinical Scholar in Residence Program, the American Geriatric Society, and the Hartford Foundation. The sponsors had no influence over the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
ASJC Scopus subject areas
- Surgery
