Journal of the American College of Surgeons
-
The American College of Surgeons NSQIP offers a Surgical Risk Calculator (SRC) that provides detailed, patient-level, risk assessments for many adverse outcomes to surgeons, patients, and the general public. The SRC calculator was designed to help guide discussion and decisions by providing generally applicable (not hospital-specific) information about surgical risk using easily understood and broadly available preoperative variables. Although large, internal evaluations have shown that the SRC has good accuracy (model discrimination and calibration), external validations have been inconsistent and tend to favor a conclusion of inadequate performance. ⋯ The SRC predictive failures, reported by studies with the described design limitations, should not be misunderstood as disqualifying the SRC as an accurate and appropriate tool for its intended purpose of providing a general purpose risk calculator, applicable across many surgical domains, using easily understood and generally available predictive information.
-
Laparoscopic hepatectomy continues to be a challenging operation associated with a steep learning curve. This study aimed to evaluate the learning process during 15 years of experience with laparoscopic hepatectomy and to identify approaches to standardization of this procedure. ⋯ Our 15-year experience clearly demonstrates the stepwise procedural evolution from LLS through left hepatectomy to right hepatectomy, as well as the trend in indications from benign-borderline tumor/living donor to malignant tumors. In contrast to LLS and left hepatectomy, a learning curve was not observed for right hepatectomy. The ongoing development process can contribute to faster standardization necessary for future advances in laparoscopic hepatectomy.
-
Comparative Study
Comparison of Conflict of Interest among Published Hernia Researchers Self-Reported to the Centers of Medicare and Medicaid Services Open Payments Database.
Many healthcare providers have financial interests and relationships with healthcare companies. To maintain transparency, investigators are expected to disclose their conflicts of interest (COIs). Recently, the Centers for Medicare and Medicaid Services developed the Open Payment database of COIs reported by industry. We hypothesize that there is discordance between industry-reported and physician self-reported COIs in ventral hernia publications. ⋯ There is substantial discordance between self-reported COI in published articles compared with those in the Centers for Medicare and Medicaid Services Open Payments database. Additional studies are needed to determine the reasons for these differences, as COI can influence the validity of the design, conduct, and results of a study.
-
As the current healthcare structure moves toward value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications and generate insight into sustainability of quality. ⋯ Postoperative complications add an important marginal cost to Medicare payments, and lead to a substantial portion of payments to hospitals. Using high-quality clinical registry data to measure complication rates, we estimated the cost of complications for 3 commonly performed operations among the Medicare population. Harmonizing financial incentives for both payers and providers are needed to improve the delivery of high-quality surgical care.
-
Preoperative chemotherapy is a strategy for converting to resection and/or assessing disease biology before operation. The utility of such an approach in gallbladder carcinoma (GBCA) is unknown. This study evaluated outcomes of GBCA patients treated with chemotherapy for locally advanced or lymph node-involved tumors. ⋯ Even without distant metastases, locally advanced or lymph node-positive GBCA is associated with poor outcomes. Definitive resection was possible in a subset of patients selected for surgery after a favorable response to chemotherapy and was associated with long-term survival. We recommend surgical re-evaluation after chemotherapy to select potential operative candidates.