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Surgical Apgar Score (SAS) predicts perioperative morbidity and length of stay in patients undergoing esophagectomy at a high-volume center
Vol. 221, No. 4S2, October 2015
Repeat readmission following major surgery among patients with employer-provided health insurance Yuhree Kim, MD, MPH, Gaya Spolverato, MD, Aslam Ejaz, MD, MPH, Eric B Schneider, PhD, Joseph K Canner, MHS, Stefan Buettner, Li Xu, MD, Timothy M Pawlik, MD, FACS The Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Most studies only report data on the first readmission within 30 days of discharge. These data may underestimate the true impact of readmission, as some patients may experience repeat readmissions after major surgery. We therefore sought to define the incidence, as well as factors associated with repeat readmission. METHODS: Patients discharged after any one of ten major surgical procedures (CABG, AAA, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, colorectal resection) between 2010-2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365-days of discharge was assessed and factors associated with repeat readmission were evaluated. RESULTS: 188,208 patients were identified; mean patient age was 52.2 years, 52.5% were male, and 37.0% had a Charlson Comorbidity Index (CCI) 2. Among 48,252 (25.6%) patients who experienced readmission, 61.3% experienced 1 readmission while 38.7% experienced 2 readmissions. Compared with 1 readmission, patients with 2 readmissions were more likely to be female (47.1% vs 44.3%), have comorbidities (CCI 2, 51.0% vs 43.0%), and have had a complication during the index hospitalization (34.2% vs 29.0%) (all p<0.001). While median length of stay was longer among patients with 2 readmissions (8 vs 6 days), time to readmission was shorter (33 vs 72 days, both p<0.001). A subset of patients (15.0%) experienced 3 readmissions, yet accounted for 37% of all readmissions. CONCLUSIONS: Among readmitted patients, roughly 2 in 5 had multiple readmissions. While only a small subset of patients had 3 readmissions, these readmissions accounted for 37% of all readmissions following major surgery. Surgical Apgar Score (SAS) predicts perioperative morbidity and length of stay in patients undergoing esophagectomy at a high-volume center Andrew B Morgan, Andrea Irizarry, MD, Nathaniel R Evans, MD, FACS, FCCP, Benjamin E Leiby, PhD, Karen A Chojnacki, MD, FACS, Ernest L Rosato, MD, FACS, Adam C Berger, MD, FACS Thomas Jefferson University, Philadelphia, PA INTRODUCTION: Esophagectomy is associated with considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy.
Scientific Poster Presentations: 2015 Clinical Congress
e89
METHODS: We examined 212 patients undergoing esophagectomy between January 2005 and April 2014. Postoperative complications were graded using the Clavien-Dindo scale, and SAS (range 0-10), was determined. Association of SAS with incidence of anastomotic leak and complications was evaluated using the Cochran Armitage trend test between grouped SAS scores (0-2, 3-4, 5-6, 7-8, 9-10) and each outcome. Correlation of Apgar score with length of stay was evaluated using competing risks proportional hazards regression. RESULTS: The average patient age was 63.5 years (range 31-86), and the average blood loss was 300 ml (range 50-4000). The median length of stay was 18.5 days. There was a significant association between SAS and Grade 3 or higher complications (p<0.0001), but not with anastomotic leak (p¼0.29). Length of stay was also associated with SAS (p<0.0001) with higher scores being associated with shorter length of stay. The perioperative mortality rate was 5.2% (n¼11); this was significantly associated with SAS (p¼0.0006). Adjustment for age did not change the significance of the associations. CONCLUSIONS: We demonstrate that SAS is a significant predictor of complications and length of stay for patients undergoing esophagectomy. This score should be used to identify patients at lower risk in order to prioritize use of postoperative critical care beds and hospital resources. The effect of tramadol on diagnostic confidence and pain reduction in adult patients with right lower quadrant pain: a double blind randomized controlled trial Johann Paulo S Guzman, MD, Nilo C Delos Santos, FACS, Omar O Ocampo, MD East Avenue Medical Center, Quezon City, Philippines INTRODUCTION: This study aimed to determine the effect of tramadol vs placebo on pain reduction and diagnostic confidence in adult patients with right lower quadrant abdominal pain. METHODS: This is a prospective double-blinded randomized controlled trial conducted by the Department of Surgery in a Tertiary Philippine Government Hospital that compared the effect of tramadol vs placebo on abdominal pain and tenderness scale; and the diagnostic confidence on adult patients with acute onset of right lower quadrant abdominal pain from July 1, 2013 to November 30, 2013. Variables such as diagnostic confidence, abdominal pain scale and abdominal tenderness scale were recorded and analyzed. RESULTS: The mean age of patients is 37.5 years 5.05. There are larger proportions of males compared to females (2.69:1). The mean abdominal pain VAS score (p ¼ 0.02) and abdominal tenderness VAS score (p ¼ 0.02) of the subjects in the tramadol group was significantly lower after the intravenous administration of the analgesic. The intravenous administration of tramadol significantly reduced the abdominal pain scale (p ¼ 0.001) and abdominal tenderness scale (p ¼ 0.001) compared to placebo as measured by the VAS. The mean diagnostic confidence before and after intervention has no significant difference in both groups of subjects operated and observed in both the tramadol and placebo groups.
Repeat readmission following major surgery among patients with employer-provided health insurance Yuhree Kim, MD, MPH, Gaya Spolverato, MD, Aslam Ejaz, MD, MPH, Eric B Schneider, PhD, Joseph K Canner, MHS, Stefan Buettner, Li Xu, MD, Timothy M Pawlik, MD, FACS The Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Most studies only report data on the first readmission within 30 days of discharge. These data may underestimate the true impact of readmission, as some patients may experience repeat readmissions after major surgery. We therefore sought to define the incidence, as well as factors associated with repeat readmission. METHODS: Patients discharged after any one of ten major surgical procedures (CABG, AAA, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, colorectal resection) between 2010-2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365-days of discharge was assessed and factors associated with repeat readmission were evaluated. RESULTS: 188,208 patients were identified; mean patient age was 52.2 years, 52.5% were male, and 37.0% had a Charlson Comorbidity Index (CCI) 2. Among 48,252 (25.6%) patients who experienced readmission, 61.3% experienced 1 readmission while 38.7% experienced 2 readmissions. Compared with 1 readmission, patients with 2 readmissions were more likely to be female (47.1% vs 44.3%), have comorbidities (CCI 2, 51.0% vs 43.0%), and have had a complication during the index hospitalization (34.2% vs 29.0%) (all p<0.001). While median length of stay was longer among patients with 2 readmissions (8 vs 6 days), time to readmission was shorter (33 vs 72 days, both p<0.001). A subset of patients (15.0%) experienced 3 readmissions, yet accounted for 37% of all readmissions. CONCLUSIONS: Among readmitted patients, roughly 2 in 5 had multiple readmissions. While only a small subset of patients had 3 readmissions, these readmissions accounted for 37% of all readmissions following major surgery. Surgical Apgar Score (SAS) predicts perioperative morbidity and length of stay in patients undergoing esophagectomy at a high-volume center Andrew B Morgan, Andrea Irizarry, MD, Nathaniel R Evans, MD, FACS, FCCP, Benjamin E Leiby, PhD, Karen A Chojnacki, MD, FACS, Ernest L Rosato, MD, FACS, Adam C Berger, MD, FACS Thomas Jefferson University, Philadelphia, PA INTRODUCTION: Esophagectomy is associated with considerable morbidity. Many studies have evaluated factors to predict patients at risk and improve clinical outcomes. The aim of this study was to determine whether the SAS predicts complications, length of stay, and anastomotic leak for patients undergoing esophagectomy.
Scientific Poster Presentations: 2015 Clinical Congress
e89
METHODS: We examined 212 patients undergoing esophagectomy between January 2005 and April 2014. Postoperative complications were graded using the Clavien-Dindo scale, and SAS (range 0-10), was determined. Association of SAS with incidence of anastomotic leak and complications was evaluated using the Cochran Armitage trend test between grouped SAS scores (0-2, 3-4, 5-6, 7-8, 9-10) and each outcome. Correlation of Apgar score with length of stay was evaluated using competing risks proportional hazards regression. RESULTS: The average patient age was 63.5 years (range 31-86), and the average blood loss was 300 ml (range 50-4000). The median length of stay was 18.5 days. There was a significant association between SAS and Grade 3 or higher complications (p<0.0001), but not with anastomotic leak (p¼0.29). Length of stay was also associated with SAS (p<0.0001) with higher scores being associated with shorter length of stay. The perioperative mortality rate was 5.2% (n¼11); this was significantly associated with SAS (p¼0.0006). Adjustment for age did not change the significance of the associations. CONCLUSIONS: We demonstrate that SAS is a significant predictor of complications and length of stay for patients undergoing esophagectomy. This score should be used to identify patients at lower risk in order to prioritize use of postoperative critical care beds and hospital resources. The effect of tramadol on diagnostic confidence and pain reduction in adult patients with right lower quadrant pain: a double blind randomized controlled trial Johann Paulo S Guzman, MD, Nilo C Delos Santos, FACS, Omar O Ocampo, MD East Avenue Medical Center, Quezon City, Philippines INTRODUCTION: This study aimed to determine the effect of tramadol vs placebo on pain reduction and diagnostic confidence in adult patients with right lower quadrant abdominal pain. METHODS: This is a prospective double-blinded randomized controlled trial conducted by the Department of Surgery in a Tertiary Philippine Government Hospital that compared the effect of tramadol vs placebo on abdominal pain and tenderness scale; and the diagnostic confidence on adult patients with acute onset of right lower quadrant abdominal pain from July 1, 2013 to November 30, 2013. Variables such as diagnostic confidence, abdominal pain scale and abdominal tenderness scale were recorded and analyzed. RESULTS: The mean age of patients is 37.5 years 5.05. There are larger proportions of males compared to females (2.69:1). The mean abdominal pain VAS score (p ¼ 0.02) and abdominal tenderness VAS score (p ¼ 0.02) of the subjects in the tramadol group was significantly lower after the intravenous administration of the analgesic. The intravenous administration of tramadol significantly reduced the abdominal pain scale (p ¼ 0.001) and abdominal tenderness scale (p ¼ 0.001) compared to placebo as measured by the VAS. The mean diagnostic confidence before and after intervention has no significant difference in both groups of subjects operated and observed in both the tramadol and placebo groups.