scholarly journals Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program

2014 ◽  
Vol 60 (5) ◽  
pp. 1315-1324 ◽  
Author(s):  
Thomas Curran ◽  
Jennifer Q. Zhang ◽  
Ruby C. Lo ◽  
Margriet Fokkema ◽  
John C. McCallum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Lower Extremity ◽  
Lower Extremity Amputation ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons ◽  
Extremity Amputation

Risk Factors for Conversion from Laparoscopic to Open Surgery: Analysis of 2138 Converted Operations in the American College of Surgeons National Surgical Quality Improvement Program

2013 ◽  
Vol 79 (9) ◽  
pp. 914-921 ◽  
Author(s):  
Dominic Papandria ◽  
Thomas Lardaro ◽  
Daniel Rhee ◽  
Gezzer Ortega ◽  
Amany Gorgy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Open Surgery ◽  
Quality Improvement Program ◽  
Laparoscopic Procedure ◽  
Improvement Program ◽  
Cross Sectional ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
American College Of Surgeons

Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n = 1526 [1.9%]) and LCO bariatric procedures were less likely (n = 121 [0.3%]); appendectomy was intermediate (n = 491 [1.0%], P < 0.001). Patient factors associated with LCO included male sex ( P < 0.001), age 30 years or older ( P < 0.025), American Society of Anesthesiologists Class 2 to 4 ( P < 0.001), obesity ( P < 0.01), history of bleeding disorder ( P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis ( P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room ( P < 0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients.

scholarly journals Risk Factors for Venous Thromboembolism following Thoracolumbar Surgery: Analysis of 43,777 Patients from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012

2016 ◽  
Vol 6 (8) ◽  
pp. 738-743 ◽  
Author(s):  
Arjun S. Sebastian ◽  
Bradford L. Currier ◽  
Sanjeev Kakar ◽  
Emily C. Nguyen ◽  
Amy E. Wagie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Spine Surgery ◽  
Thoracolumbar Spine ◽  
Quality Improvement Program ◽  
National Database ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons

Study Design Retrospective clinical study of a prospectively collected, national database. Objective Determine the 30-day incidence, timing, and risk factors for venous thromboembolism (VTE) following thoracolumbar spine surgery. Methods The American College of Surgeons National Surgical Quality Improvement Program Participant Use File identified 43,777 patients who underwent thoracolumbar surgery from 2005 to 2012. Multiple patient characteristics were identified. The incidence and timing (in days) of deep vein thrombosis (DVT) and pulmonary embolus (PE) were determined. Multivariable regression analysis was performed to identify significant risk factors. Results Of the 43,777 patients identified as having had thoracolumbar surgery, 202 cases of PE (0.5%) and 311 cases of DVT (0.7%) were identified. VTE rates were highest in patients undergoing corpectomy, with a 1.7% PE rate and a 3.8% DVT rate. Independent risk factors for VTE included length of stay (LOS) ≥ 6 days (odds ratio [OR] 4.07), disseminated cancer (OR 1.77), white blood cell count > 12 (OR 1.76), paraplegia (OR 1.75), albumin < 3 (OR 1.73), American Society of Anesthesiologists class 4 or greater (OR 1.54), body mass index > 40 (OR 1.49), and operative time > 193 minutes (OR 1.43). LOS < 3 days was protective (OR 0.427). Conclusions We report an overall 30-day PE rate of 0.5% and DVT rate of 0.7% following thoracolumbar spine surgery. Patients undergoing corpectomy were at highest risk for VTE. Multiple VTE risk factors were identified. Further studies are needed to develop algorithms to stratify VTE risk and direct prophylaxis accordingly.

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