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Levy BE, Wilt WS, Castle JT, McAtee E, Walling SC, Davenport DL, Bhakta A, Patel JA. Surgical Site Infections in Colorectal Resections: What is the Cost? J Surg Res 2023; 283:336-343. [PMID: 36427443 DOI: 10.1016/j.jss.2022.10.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/26/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although surgical site infections (SSIs) associated with colectomy are tracked by the National Healthcare Safety Network/Center for Disease Control, untracked codes, mainly related to patients undergoing proctectomy, are not. These untracked codes are performed less often yet they may be at a greater risk of SSI due to their greater complexity. Determining the impact and predictors of SSI are critical in the development of quality improvement initiatives. METHODS Following an institutional review board approval, National Surgery Quality Improvement Program, institutional National Surgery Quality Improvement Program, and financial databases were queried for tracked colorectal resections and untracked colorectal resections (UCR). National data were obtained for January 2019-December 2019, and local procedures were identified between January 2013 and December 2019. Data were analyzed for preoperative SSI predictors, operative characteristics, outcomes, and 30-day postdischarge costs (30dPDC). RESULTS Nationally, 71,705 colorectal resections were identified, and institutionally, 2233 patients were identified. UCR accounted for 7.9% nationally and 11.8% of all colorectal resections institutionally. Tracked colorectal resection patients had a higher incidence of SSI predictors including sepsis, hypoalbuminemia, coagulopathy, hypertension, and American Society of Anesthesiologists class. UCR patients had a higher rate of SSIs [12.9% (P < 0.001), 15.2% (P = 0.064)], readmission, and unplanned return to the operating room. Index hospitalization and 30dPDC were significantly higher in patients experiencing an SSI. CONCLUSIONS SSI was associated with nearly a two-fold increase in index hospitalization costs and six-fold in 30dPDC. These data suggest opportunities to improve hospitalization costs and outcomes for patients undergoing UCR through protocols for SSI reduction and preventing readmissions.
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Affiliation(s)
- Brittany E Levy
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.
| | - Wesley S Wilt
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jennifer T Castle
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin McAtee
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Samuel C Walling
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel L Davenport
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Avinash Bhakta
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Jitesh A Patel
- Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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Gan T, Sinner HF, Walling SC, Chen Q, Huang B, Tucker TC, Patel JA, Evers BM, Bhakta AS. Impact of the Affordable Care Act on Colorectal Cancer Screening, Incidence, and Survival in Kentucky. J Am Coll Surg 2019; 228:342-353.e1. [PMID: 30802505 DOI: 10.1016/j.jamcollsurg.2018.12.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky. STUDY DESIGN The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation. RESULTS Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (-1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage. CONCLUSIONS Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.
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Affiliation(s)
- Tong Gan
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Heather F Sinner
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Samuel C Walling
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY
| | - Quan Chen
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY; Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, Lexington, KY
| | - Bin Huang
- Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY; Biostatistics and Bioinformatics Shared Resource Facility, Markey Cancer Center, Lexington, KY
| | - Tom C Tucker
- Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Jitesh A Patel
- Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - B Mark Evers
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY
| | - Avinash S Bhakta
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY; Markey Cancer Center, University of Kentucky Medical Center, Lexington, KY.
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