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Impact of Hepatectomy Surgical Complexity on Outcomes and Hospital Quality Rankings

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is substantial variation in the surgical complexity of hepatectomy. Currently, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk adjusts for hospital quality comparisons using only the primary procedure code. Our objectives were to (1) assess the association between secondary procedures and complications; (2) assess model performance with inclusion of surgical complexity adjustment; and (3) examine whether secondary procedures affect hospital quality rankings.

Methods

Using ACS NSQIP (2007–2012), patients undergoing hepatectomy were identified. Secondary procedure codes and total work relative value units (RVUs) were used to approximate procedural complexity. The effect of procedural complexity variables on outcomes and hospital quality rankings were examined using hierarchical models.

Results

Among 11,826 patients who underwent hepatectomy at 261 hospitals, 32.8 % underwent at least one secondary procedure. Serious morbidity occurred in 18.0 % of patients. Seven of nine secondary procedures were significantly associated with death or serious morbidity on multivariable analysis. Model performance improved when secondary procedure categories were included, and secondary procedure categories outperformed total RVUs. The C-statistic for death or serious morbidity was 0.689 in the standard NSQIP model, 0.703 when total RVU was included, and 0.718 when secondary procedure categories were included. Of the 26 hospitals that were poor performers for death or serious morbidity using the standard ACS NSQIP model, three became average performers when secondary procedure categories were included in the model.

Conclusions

Secondary procedures are associated with an increased risk of postoperative complications. Inclusion of secondary procedure code categories in research and risk prediction models should be considered for hepatectomy.

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Acknowledgment

This work was supported in part by the American Cancer Society (Drs. Merkow and Bilimoria) and the National Comprehensive Cancer Network (Dr. Bilimoria).

Disclosures

Dr. Paruch’s ACS Clinical Scholars in Residence fellowship is supported by the American College of Surgeons, the University of Chicago, Northwestern University, and an unrestricted educational grant from Genentech, which had no input into the selection of the recipient, research topic, research direction, or the content of any resulting report, presentation, or publication.

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Authors and Affiliations

  1. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Jennifer L. Paruch MD, Ryan P. Merkow MD, MS, Clifford Y. Ko MD, MS, MSHS, Mark E. Cohen PhD & Karl Y. Bilimoria MD, MS

  2. Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Jennifer L. Paruch MD, Ryan P. Merkow MD, MS & Mitchell C. Posner MD

  3. Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow MD, MS, David J. Bentrem MD & Karl Y. Bilimoria MD, MS

  4. Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow MD, MS, David J. Bentrem MD & Karl Y. Bilimoria MD, MS

  5. Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem MD

  6. Department of Surgery, University of California, Los Angeles, CA, USA

    Clifford Y. Ko MD, MS, MSHS

  7. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Clifford Y. Ko MD, MS, MSHS

  8. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD, MS

Authors
  1. Jennifer L. Paruch MD
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  2. Ryan P. Merkow MD, MS
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  3. David J. Bentrem MD
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  4. Clifford Y. Ko MD, MS, MSHS
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  5. Mitchell C. Posner MD
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  6. Mark E. Cohen PhD
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  7. Karl Y. Bilimoria MD, MS
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  8. Sharon M. Weber MD, MS
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Corresponding author

Correspondence to Jennifer L. Paruch MD.

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Paruch, J.L., Merkow, R.P., Bentrem, D.J. et al. Impact of Hepatectomy Surgical Complexity on Outcomes and Hospital Quality Rankings. Ann Surg Oncol 21, 1773–1780 (2014). https://doi.org/10.1245/s10434-014-3500-5

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  • DOI: https://doi.org/10.1245/s10434-014-3500-5

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