Journal of the American College of Surgeons
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Multicenter Study
Value of primary operative drain placement after major hepatectomy: a multi-institutional analysis of 1,041 patients.
The value of routine primary (intraoperative) drain placement after major hepatectomy remains unclear. We sought to determine if primary drainage led to decreased rates of complications, specifically, intra-abdominal biloma or infection requiring a secondary (postoperative) drainage procedure. ⋯ Primary intraoperative drain placement after major hepatectomy does not decrease the need for secondary drainage procedures and may be associated with increased bile leaks and 30-day readmissions. Routine drain placement is not warranted.
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Multicenter Study
Use of radioiodine after thyroid lobectomy in patients with differentiated thyroid cancer: does it change outcomes?
Radioiodine (RAI) lobe ablation in lieu of completion thyroidectomy is not recommended. This study describes RAI use patterns and outcomes in patients with well-differentiated thyroid cancer (DTC) after thyroid lobectomy (TL). ⋯ A total of 32,119 patients (20%) underwent TL as the definitive procedure. Mean age at diagnosis was 48 years, median tumor size was 1 cm, 4% had extrathyroidal extension, 4% had positive lymph nodes, and <1% distant metastases. Radioiodine was administered to 24% of patients in the TL cohort and represented 10% of the overall RAI use. In multivariate analysis, RAI use was associated with age younger than 45 years (odds ratio [OR] = 1.51), community facilities (OR = 1.26), ≥ 1 cm tumors (OR = 5.67), stage II (OR = 1.54) or III (OR = 2.05), positive lymph nodes (OR = 1.78), and extrathyroidal extension (OR = 1.36). On both univariate and multivariate analysis, RAI after TL was associated with improved survival at both 5 and 10 years follow-up (97% vs 95% and 91% vs 89%, respectively; hazard ratio = 0.53; 95% CI, 0.38-0.72; p < 0.001) CONCLUSIONS: Nearly one quarter of TL patients received RAI. The strongest predictors of RAI use were larger cancers and advanced stage. Use of RAI in these patients was associated with improved overall survival. Future studies and guidelines will need to more clearly address this practice and educate providers about the appropriate use of RAI in TL patients.
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Multicenter Study
How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee Surgical Quality Collaborative.
The Tennessee Surgical Quality Collaborative analyzes NSQIP data from 21 participating hospitals. The Tennessee Surgical Quality Collaborative has reduced surgical complications, but causative factors are unclear. We sought to correlate surgical duration with complications to reveal mitigating strategies. ⋯ Duration of operation correlates with complications and time longer than a statewide established standard carries higher risk. To reduce risk of complications, these data support expeditious surgical technique and preoperative pulmonary training, and offer accurate outcomes assessment for patient counseling based on case duration. These data can be used directly to counsel individual surgeons to improve outcomes.
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Multicenter Study
Surgical treatment of hepatocellular carcinoma in North America: can hepatic resection still be justified?
The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC. ⋯ The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.
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Randomized Controlled Trial Multicenter Study
A novel risk scoring system reliably predicts readmission after pancreatectomy.
Postoperative readmissions have been proposed by Medicare as a quality metric and can impact provider reimbursement. Because readmission after pancreatectomy is common, we sought to identify factors associated with readmission to establish a predictive risk scoring system. ⋯ The RAP score is a novel and clinically useful risk scoring system for readmission after pancreatectomy. Identification of patients with increased risk of readmission using the RAP score will allow efficient resource allocation aimed to attenuate readmission rates. It also has potential to serve as a new metric for comparative research and quality assessment.