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Is a Colectomy Always Just a Colectomy? Additional Procedures as a Proxy for Operative Complexity.
Simmons, Kristina D; Hoffman, Rebecca L; Kuo, Lindsay E; Bartlett, Edmund K; Holena, Daniel N; Kelz, Rachel R.
Afiliação
  • Simmons KD; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Hoffman RL; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Kuo LE; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Bartlett EK; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Holena DN; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
  • Kelz RR; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: Rachel.Kelz@uphs.upenn.edu.
J Am Coll Surg ; 221(4): 862-70.e1-2, 2015 Oct.
Article em En | MEDLINE | ID: mdl-26228014
BACKGROUND: Studies of surgical outcomes can be confounded by operative complexity. Complexity is difficult to assess from claims data due to the absence of established measures, but information on additional procedures is typically available. We hypothesized that analyzing same-day procedures (SDPs) would provide a useful step toward including operative complexity in risk adjustment. STUDY DESIGN: Colon resections were identified in California, Florida, and New York (2008 to 2011). Same-day procedures were categorized using 6 definitions. In-hospital mortality and postoperative complications were examined. For all outcomes, we developed multivariable logistic regression models to measure the association between the SDP category and outcomes. RESULTS: Rates of SDP were 74.9% total, 69.5% surgical, 31.6% nonsurgical, 36.6% colon, 51.4% abdomen, and 34.3% other for the 215,041 colon resections examined. Mortality was associated with the inclusion of any SDP category in univariate (6.2% vs 1.7%; p < 0.001) and multivariable (odds ratio [OR] = 2.14; 95% CI, 1.99-2.30; p < 0.001) analysis. The association with mortality was high for nonsurgical (OR = 2.36; 95% CI, 2.26-2.46) and other (OR = 2.33; 95% CI, 2.23-2.43) procedures and moderate for surgical (OR = 1.45; 95% CI, 1.37-1.54) and colon (OR = 1.51; 95% CI, 1.44-1.57) procedures, but abdominal procedures were not independently associated with mortality (OR = 1.01; 95% CI, 0.97-1.06). The total number of SDPs was also associated with higher complication rates. CONCLUSIONS: The risk of complications and mortality associated with colectomy was increased among patients with SDPs and the magnitude of the association was dependent on the type and quantity of additional procedures. Information on SDPs might reflect a component of operative risk not typically captured and should be considered as a candidate variable for risk adjustment when using claims to compare outcomes across large cohorts.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Colectomia / Doenças do Colo / Medição de Risco Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Colectomia / Doenças do Colo / Medição de Risco Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos