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Polan RM, Slota JM, Barber EL. Postoperative complications in women with ovarian cancer stratified by cytoreductive surgery outcome. J Surg Oncol 2023; 128:891-901. [PMID: 37382209 PMCID: PMC10529113 DOI: 10.1002/jso.27380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To compare 30-day postoperative complications for patients with advanced ovarian cancer who underwent resection to no gross residual disease versus optimal and suboptimal cytoreduction. METHODS A retrospective cohort study of women drawn from the National Surgical Quality Improvement Program who underwent cytoreductive surgery for advanced ovarian cancer between 2014 and 2019 was performed. Exposure of interest was extent of surgical resection defined as no gross residual disease; residual disease <1 cm (optimal); and residual disease >1 cm (suboptimal). Primary outcome was postoperative complication. Associations were examined with bivariable tests and multivariable logistic regression. RESULTS A total of 2248 women underwent cytoreductive surgery; 68.4% (n = 1538) underwent resection to no gross residual disease, 22.4% (n = 504) had an optimal, and 9.2% (n = 206) had a suboptimal cytoreduction. Optimal cytoreduction patients had the highest rates of any postoperative complication (35.5%, p < 0.001). They also had the longest operative times and procedures that were most surgically complex (203 min, 43.6 relative value units, both p < 0.05). However, patients who underwent optimal cytoreduction did not have increased odds of major complications (adjusted odds ratio: 1.20, 95% confidence interval: 0.91-1.58). CONCLUSION Patients who underwent optimal cytoreduction had more postoperative complications, required the most operating room time, and represented more complex surgeries compared with suboptimal cytoreduction or resection to no gross residual disease.
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Affiliation(s)
- Rosa M Polan
- Division of Gynecology Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Jennifer M Slota
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University, Chicago, Illinois, USA
| | - Emma L Barber
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University, Chicago, Illinois, USA
- Department of Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
- Department of Gynecology, Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, Illinois, USA
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Brajcich BC, Johnson JK, Holl JL, Bilimoria KY, Ager MS, Chung J, Joung RHS, Iroz CB, Odell DD, Bentrem DJ, Yang AD, Franklin PD, Slota JM, Silver CM, Skolarus T, Merkow RP. Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery. J Surg Oncol 2023. [PMID: 37126379 DOI: 10.1002/jso.27292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Emergency department (ED) utilization after gastrointestinal cancer operations is poorly characterized. Our study objectives were to determine the incidence of, reasons for, and predictors of ED treat-and-release encounters after gastrointestinal cancer operations. METHODS Patients who underwent elective esophageal, hepatobiliary, gastric, pancreatic, small intestinal, or colorectal operations for cancer were identified in the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The primary outcomes were the incidence of ED treat-and-release encounters and readmissions within 30 days of discharge. RESULTS Among 51 527 patients at 406 hospitals, 4047 (7.9%) had an ED treat-and-release encounter, and 5573 (10.8%) had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. ED treat-and-release encounters were most frequently for pain (12.0%), device/ostomy complaints (11.7%), or wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.12-1.37) and Medicare (OR 1.27, 95% CI 1.16-1.40) or Medicaid (OR 1.82, 95% CI 1.62-2.40) coverage. CONCLUSIONS ED treat-and-release encounters are common after major gastrointestinal operations, making up nearly half of postdischarge ED encounters. The reasons for ED treat-and-release encounters differ from those for ED encounters with readmissions.
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Affiliation(s)
- Brian C Brajcich
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Julie K Johnson
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Karl Y Bilimoria
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jeanette Chung
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel Hae Soo Joung
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cassandra B Iroz
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D Odell
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Surgical Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Anthony D Yang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer M Slota
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Casey M Silver
- Department of Surgery, Northwestern Quality Improvement, Research & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Ted Skolarus
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Ryan P Merkow
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
- Department of Surgery, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
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Affiliation(s)
- Brian J Miller
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC
- Kenan-Flagler School of Business, University of North Carolina at Chapel Hill
| | - Jennifer M Slota
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jesse M Ehrenfeld
- Departments of Anesthesiology, Biomedical Informatics, Health Policy, and Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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