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10.09.2021 | SSAT Quick Shot Presentation

Trends in Textbook Outcomes over Time: Are Optimal Outcomes Following Complex Gastrointestinal Surgery for Cancer Increasing?

verfasst von: J. Madison Hyer, Joal D. Beane, Gaya Spolverato, Diamantis I. Tsilimigras, Adrian Diaz, Alessandro Paro, Djhenne Dalmacy, Timothy M. Pawlik

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 1/2022

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Abstract

Background

The use of composite measures like “textbook outcome” (TO) may provide a more accurate measure of surgical quality. We sought to determine if TO has improved over time and to characterize the association of achieving a TO with trends in survival among patients undergoing complex gastrointestinal surgery for cancer.

Methods

Medicare beneficiaries who underwent pancreas, liver, or colon resection for a cancer diagnosis between 2004 and 2016 were identified using the SEER-Medicare database. Rates of TO (no complication, extended length of stay, 90-day readmission, or 90-day mortality) were assessed over time.

Results

Among 94,329 patients, 6765 (7.2%), 1985 (2.1%), and 85,579 (90.7%) patients underwent resection for primary pancreatic, hepatic, or colon cancer, respectively. In total, 53,464 (56.7%) patients achieved a TO; achievement of TO varied by procedure (pancreatectomy: 48.1% vs. hepatectomy: 55.2% vs. colectomy: 57.4%, p < 0.001). The proportion of patients achieving a textbook outcome increased over time for all patients (2004–2007, 53.3% vs. 2008–2011, 56.5% vs. 2012–2016, 60.1%) (5-year increase: OR 1.16 95%CI 1.13–1.18) (p < 0.001). Survival at 1-year following pancreatic, liver, or colon resection for cancer had improved over time among both patients who did and did not achieve a postoperative TO. TO was independently associated with a marked reduction in hazard of death (HR 0.44, 95%CI 0.43–0.45). The association of TO and survival was consistent among patients stratified by procedure.

Conclusion

Less than two-thirds of patients undergoing complex gastrointestinal surgery for a malignant indication achieved a TO. The likelihood of achieving a TO increased over time and was associated with improved survival.

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Titel: Trends in Textbook Outcomes over Time: Are Optimal Outcomes Following Complex Gastrointestinal Surgery for Cancer Increasing?
verfasst von: J. Madison Hyer
Joal D. Beane
Gaya Spolverato
Diamantis I. Tsilimigras
Adrian Diaz
Alessandro Paro
Djhenne Dalmacy
Timothy M. Pawlik
Publikationsdatum: 10.09.2021
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 1/2022
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-021-05129-4

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Trends in Textbook Outcomes over Time: Are Optimal Outcomes Following Complex Gastrointestinal Surgery for Cancer Increasing?

Abstract

Background

Methods

Results

Conclusion

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Abstract

Background

Methods

Results

Conclusion

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