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The impact of non-alcoholic fatty liver disease on perioperative mortality and specific morbidity utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)
e96
Scientific Poster Presentations: 2014 Clinical Congress
queried to identify patients who underwent emergent surgery for a bowel obstruction. Patients were stratified by the presence of disseminated malignancy. Multivariable logistic regression was performed to determine the independent association between disseminated malignancy and mortality, adjusting for a robust array of patient-related factors. Failure-to-Rescue, defined as mortality following major complications, was also assessed. RESULTS: 4,007 patients were identified, 270 (6.7%) of which had disseminated malignancy. There were several notable differences between groups including age, functional status, baseline comorbidities, and recent use of chemotherapy or radiation. Unadjusted comparison demonstrated that postoperative morbidity occurred more frequently in patients with disseminated malignancy, as well as overall 30-day mortality (24.8% vs 7.9%, p <0.001). Disseminated malignancy remained as an independent predictor of mortality following multivariable adjustment (AOR ¼ 2.20, p¼ 0.004). Failure-to-Rescue in patients who sustained major postoperative complications was also significantly greater in patients with disseminated malignancy (34.5% vs 8.8%, p <0.001). CONCLUSIONS: Our study identifies disseminated malignancy as an independent predictor of poor outcomes after surgical intervention for bowel obstruction. The morbidity and mortality rates detailed by our analysis can be used to better inform patients with disseminated cancer and bowel obstructions about the anticipated outcomes associated with surgery. The impact of non-alcoholic fatty liver disease on perioperative mortality and specific morbidity utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Joseph B Oliver, MD, Advaith Bongu, MD, Kimberly B Nester, RN, MSN, George Dikdan, PhD, Abdel-Kareem Beidas, BA, Urvashi Pandit, MPH, MBS, Babuaro Koneru, MD, Lloyd Brown, MD, MS Rutgers New Jersey Medical School, Newark, NJ INTRODUCTION: The prevalence of non-alcoholic fatty liver disease (NAFLD) in the surgical population is increasing, however, its impact on surgical outcomes has not been well studied. We analyzed the impact of NAFLD within the National Surgical Quality Improvement Program (ACS NSQIP) database. METHODS: Data from the ACS NSQIP participant user file from 2008-2011 were analyzed. NAFLD was defined as individuals with metabolic syndrome (BMI >¼30, hypertension, and diabetes) and an abnormal AST level, without concurrent alcohol abuse. Patients with chronic liver disease, older than 89 years, undergoing procedures involving the liver and/or with disseminated cancer were excluded. Odds ratios (OR) of 30 day mortality and ACS NSQIP morbidities were adjusted for demographics, medical comorbidities, and perioperative factors using logistic regression. Metabolic syndrome was included in the regressions to isolate the effect from NAFLD. All statistics were performed in SAS 9.3.
J Am Coll Surg
RESULTS: There were 6635 cases and 1,363,081 controls. Cases were more likely to be older and medically complex. Cases had 22% higher odds of mortality, and 13% higher odds of any complication. Significant specific complications are shown in the table. Cases had a longer median (3 days vs 2 days, p<0.001), and after adjustment, an 11% (10%-12%) longer hospital length of stay. In addition, cases had 25% higher odds of being readmitted within the 30 days. CONCLUSIONS: NAFLD is associated with an increased rate of mortality and morbidity within ACS NSQIP. Better efforts should be taken to diagnosis NAFLD preoperatively, and to ameliorate the effects of it should be attempted prior to elective surgery. Postoperative renal and neurological complications should be avoided. Completion of research training during residency is associated with American Board of Surgery examination performance Andrew Jones, PhD, Whitney Smiley, MA, Thomas W Biester, MS, Mark A Malangoni, MD, FACS American Board of Surgery, Philadelphia, PA and the College Board, Bala Cynwyd, PA INTRODUCTION: Although many residents pursue research training during residency, information is limited on participation rates and outcomes. This study addressed whether residents who complete one or more years of research during residency are more likely to become board certified. METHODS: Performance of first-time American Board of Surgery (ABS) surgery qualifying exam (QE) and certifying exam (CE) examinees from 2011-2012 was analyzed (n¼ 2,052 and 2,077, respectively). Results were linked to resident rosters to determine research participation. Examinees’ PGY1 ABSITE scores were linked to QE and CE results to control for initial knowledge. Multilevel logistic regression was used to evaluate the association of research participation and examination performance. RESULTS: Thirty-one percent of residents completed > 1 year of research (ReRes). ReRes were more likely to be US medical school graduates, female, and train in larger, academic-based programs. ReRes with > 2 years of research were significantly more likely to pass the QE and CE. The QE pass rate for those with >2 years was 92.1%, 88.7% for one year, and 86.7% for no research, while the CE pass rate was 86.1%, 77.1%, and 76.5%, respectively. These differences were significant for both the QE (p ¼ .003) and CE (p ¼ .001) after controlling for initial ABSITE scores, IMG status, and program size. CONCLUSIONS: These results suggest that completion of two or more years of research training during residency is associated with a greater likelihood of passing the ABS QE and CE. Additional study is needed to explain this phenomenon.
Scientific Poster Presentations: 2014 Clinical Congress
queried to identify patients who underwent emergent surgery for a bowel obstruction. Patients were stratified by the presence of disseminated malignancy. Multivariable logistic regression was performed to determine the independent association between disseminated malignancy and mortality, adjusting for a robust array of patient-related factors. Failure-to-Rescue, defined as mortality following major complications, was also assessed. RESULTS: 4,007 patients were identified, 270 (6.7%) of which had disseminated malignancy. There were several notable differences between groups including age, functional status, baseline comorbidities, and recent use of chemotherapy or radiation. Unadjusted comparison demonstrated that postoperative morbidity occurred more frequently in patients with disseminated malignancy, as well as overall 30-day mortality (24.8% vs 7.9%, p <0.001). Disseminated malignancy remained as an independent predictor of mortality following multivariable adjustment (AOR ¼ 2.20, p¼ 0.004). Failure-to-Rescue in patients who sustained major postoperative complications was also significantly greater in patients with disseminated malignancy (34.5% vs 8.8%, p <0.001). CONCLUSIONS: Our study identifies disseminated malignancy as an independent predictor of poor outcomes after surgical intervention for bowel obstruction. The morbidity and mortality rates detailed by our analysis can be used to better inform patients with disseminated cancer and bowel obstructions about the anticipated outcomes associated with surgery. The impact of non-alcoholic fatty liver disease on perioperative mortality and specific morbidity utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Joseph B Oliver, MD, Advaith Bongu, MD, Kimberly B Nester, RN, MSN, George Dikdan, PhD, Abdel-Kareem Beidas, BA, Urvashi Pandit, MPH, MBS, Babuaro Koneru, MD, Lloyd Brown, MD, MS Rutgers New Jersey Medical School, Newark, NJ INTRODUCTION: The prevalence of non-alcoholic fatty liver disease (NAFLD) in the surgical population is increasing, however, its impact on surgical outcomes has not been well studied. We analyzed the impact of NAFLD within the National Surgical Quality Improvement Program (ACS NSQIP) database. METHODS: Data from the ACS NSQIP participant user file from 2008-2011 were analyzed. NAFLD was defined as individuals with metabolic syndrome (BMI >¼30, hypertension, and diabetes) and an abnormal AST level, without concurrent alcohol abuse. Patients with chronic liver disease, older than 89 years, undergoing procedures involving the liver and/or with disseminated cancer were excluded. Odds ratios (OR) of 30 day mortality and ACS NSQIP morbidities were adjusted for demographics, medical comorbidities, and perioperative factors using logistic regression. Metabolic syndrome was included in the regressions to isolate the effect from NAFLD. All statistics were performed in SAS 9.3.
J Am Coll Surg
RESULTS: There were 6635 cases and 1,363,081 controls. Cases were more likely to be older and medically complex. Cases had 22% higher odds of mortality, and 13% higher odds of any complication. Significant specific complications are shown in the table. Cases had a longer median (3 days vs 2 days, p<0.001), and after adjustment, an 11% (10%-12%) longer hospital length of stay. In addition, cases had 25% higher odds of being readmitted within the 30 days. CONCLUSIONS: NAFLD is associated with an increased rate of mortality and morbidity within ACS NSQIP. Better efforts should be taken to diagnosis NAFLD preoperatively, and to ameliorate the effects of it should be attempted prior to elective surgery. Postoperative renal and neurological complications should be avoided. Completion of research training during residency is associated with American Board of Surgery examination performance Andrew Jones, PhD, Whitney Smiley, MA, Thomas W Biester, MS, Mark A Malangoni, MD, FACS American Board of Surgery, Philadelphia, PA and the College Board, Bala Cynwyd, PA INTRODUCTION: Although many residents pursue research training during residency, information is limited on participation rates and outcomes. This study addressed whether residents who complete one or more years of research during residency are more likely to become board certified. METHODS: Performance of first-time American Board of Surgery (ABS) surgery qualifying exam (QE) and certifying exam (CE) examinees from 2011-2012 was analyzed (n¼ 2,052 and 2,077, respectively). Results were linked to resident rosters to determine research participation. Examinees’ PGY1 ABSITE scores were linked to QE and CE results to control for initial knowledge. Multilevel logistic regression was used to evaluate the association of research participation and examination performance. RESULTS: Thirty-one percent of residents completed > 1 year of research (ReRes). ReRes were more likely to be US medical school graduates, female, and train in larger, academic-based programs. ReRes with > 2 years of research were significantly more likely to pass the QE and CE. The QE pass rate for those with >2 years was 92.1%, 88.7% for one year, and 86.7% for no research, while the CE pass rate was 86.1%, 77.1%, and 76.5%, respectively. These differences were significant for both the QE (p ¼ .003) and CE (p ¼ .001) after controlling for initial ABSITE scores, IMG status, and program size. CONCLUSIONS: These results suggest that completion of two or more years of research training during residency is associated with a greater likelihood of passing the ABS QE and CE. Additional study is needed to explain this phenomenon.