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organ space surgical site infections in pancreatectomy
S74
Mini Oral Session Abstracts
higher severity of illness (SOI) (60.4% extreme vs. 20.3% vs. 12.6% vs. 5.7%; p < 0.01). Having a high transfusion requirement correlated with higher readmission rates (OR 1.19, p = 0.04), higher cost (RR 1.92, p < 0.01), increased length of stay (19 vs. 12 vs. 10 vs. 8 days; p < 0.01) and inhospital mortality (15% vs. 2% vs. 0.4% vs. 0.4%; p < 0.01). A negative correlation was identified between surgeon volume and transfusion requirements, with higher volume surgeons demonstrating lower transfusion requirements (OR 0.61, p < 0.01). Conclusion: This is the first report to show that significant variability exists nationally in transfusion practices for patients undergoing PD, which directly influences patient outcomes and resource utilization. Efforts to reduce such variability could lead to improved outcomes and healthcare cost savings.
Table Multivariable analysis for predictors of readmission,
cost, and high transfusion use in patients undergoing pancreaticoduodenectomy. Readmission Cost OR
pvalue
RR
High transfusion use p-value OR
pvalue
Transfusion group (Ref = None] Low
0.95
0.62
1.11 <0.01
Medium
0.95
0.62
1.11 <0.01
High
1.19
0.04
1.92 <0.01
Methods: ACS-NSQIP targeted pancreas 2014 database was queried for patients undergoing pancreatectomy. Rates and predictors of superficial and deep/organ SSI and effects of SSI type on readmission and LOS were examined using multivariate logistic and generalized linear models. Results: In 4088 patients, rates of superficial and deep/ organ SSI were 9.6% and 15.5%, respectively. Significant predictors for superficial SSI were preoperative biliary stent (OR 2.44) and each additional operative hour (OR 1.10). Predictors for deep/organ SSI: BMI 30 (OR 1.76), pancreatic duct <3 mm (OR 1.44), open approach (OR 1.56), soft pancreatic texture (OR 1.93), proximal pancreatectomy (OR 1.60) each additional hour (OR 1.08), contaminated/dirty wound (OR 1.35) and steroids (OR 1.68). Median LOS was significantly longer with superficial and deep/organ space SSI (9 and 13 vs 7 days, p < 0.0001). Of 698 (17.1%) readmissions, 33(4.7%) and 161(23.1%) were due to superficial and deep/organ SSI. On multivariate modelling, superficial and deep/organ SSI remained significant predictors of LOS (RR 1.14 and 1.61) and readmission (OR 2.99 and 6.90). Conclusion: While traditional measures such as biliary stenting and operative time drive superficial SSI, deep/ organ SSI are impacted by predictors more specific to anastomotic leak, contaminated field, and immunosuppression/metabolic syndrome. Our data demonstrates that prolonged LOS and readmissions are dominated by deep/ organ SSI, suggesting future strategies should focus on preferential prevention of deep/organ space infections.
DRG (Ref = No CC) CC
1.23
0.02
1.10 <0.01
3.07
<0.01
Major CC 1.26
0.03
1.14 0.01
4.59
<0.01
Other
<0.01
1.27 <0.01
5.59
<0.01
Moderate
1.19 <0.01
2.65
0.32
Major
1.36 <0.01
5.31
0.07
Extreme
2.49 <0.01
51.8
<0.01
1.66
SOI (Ref = Minor)
Center volume (Ref = Low) Medium
0.85
<0.01
High
0.68
<0.01
Surgeon volume (Ref = Low) Medium
0.95 <0.01
0.61
<0.01
High
0.94 0.01
0.61
<0.01
CC = comorbidities/complications, SOI = severity of illness.
MO 78 UNIQUE PREDICTORS OF SUPERFICIAL AND DEEP/ORGAN SPACE SURGICAL SITE INFECTIONS IN PANCREATECTOMY A. Fadayomi, G. Kasumova, O. Tabatabaie, S. de Geus, T. Kent, S. Ng, A. Moser, M. Callery, S. Ashley and J. Tseng Beth Israel Deaconess Medical Center, Boston, MA, USA Objective: Despite differences in etiology of superficial and deep/organ space infections, studies have grouped all SSIs together. We identified unique predictors for each SSI type and evaluated their effects on readmission and length of stay (LOS).
MO 79 GEOGRAPHIC REGION IS ASSOCIATED WITH TREATMENT AND SURVIVAL OUTCOMES FOR PANCREATIC CANCER A. Salami and A. Joshi Einstein Medical Center, Philadelphia, PA, USA Objective: We sought to assess the impact of geographic region on treatment characteristics and survival for pancreatic adenocarcinoma. Methods: The SEER registry was used to identify patients with potentially resectable pancreatic adenocarcinoma (AJCC IeIII) diagnosed between 2004 and 2013. The exposure of interest was geographic region of diagnosis: West (WE), South (SO) or North-East (NE). The endpoints of interest were: (1) recommendation of no surgery by the provider (2) utilization of resection and (3) disease-specific HPB 2017, 19 (S1), S40eS108
Mini Oral Session Abstracts
higher severity of illness (SOI) (60.4% extreme vs. 20.3% vs. 12.6% vs. 5.7%; p < 0.01). Having a high transfusion requirement correlated with higher readmission rates (OR 1.19, p = 0.04), higher cost (RR 1.92, p < 0.01), increased length of stay (19 vs. 12 vs. 10 vs. 8 days; p < 0.01) and inhospital mortality (15% vs. 2% vs. 0.4% vs. 0.4%; p < 0.01). A negative correlation was identified between surgeon volume and transfusion requirements, with higher volume surgeons demonstrating lower transfusion requirements (OR 0.61, p < 0.01). Conclusion: This is the first report to show that significant variability exists nationally in transfusion practices for patients undergoing PD, which directly influences patient outcomes and resource utilization. Efforts to reduce such variability could lead to improved outcomes and healthcare cost savings.
Table Multivariable analysis for predictors of readmission,
cost, and high transfusion use in patients undergoing pancreaticoduodenectomy. Readmission Cost OR
pvalue
RR
High transfusion use p-value OR
pvalue
Transfusion group (Ref = None] Low
0.95
0.62
1.11 <0.01
Medium
0.95
0.62
1.11 <0.01
High
1.19
0.04
1.92 <0.01
Methods: ACS-NSQIP targeted pancreas 2014 database was queried for patients undergoing pancreatectomy. Rates and predictors of superficial and deep/organ SSI and effects of SSI type on readmission and LOS were examined using multivariate logistic and generalized linear models. Results: In 4088 patients, rates of superficial and deep/ organ SSI were 9.6% and 15.5%, respectively. Significant predictors for superficial SSI were preoperative biliary stent (OR 2.44) and each additional operative hour (OR 1.10). Predictors for deep/organ SSI: BMI 30 (OR 1.76), pancreatic duct <3 mm (OR 1.44), open approach (OR 1.56), soft pancreatic texture (OR 1.93), proximal pancreatectomy (OR 1.60) each additional hour (OR 1.08), contaminated/dirty wound (OR 1.35) and steroids (OR 1.68). Median LOS was significantly longer with superficial and deep/organ space SSI (9 and 13 vs 7 days, p < 0.0001). Of 698 (17.1%) readmissions, 33(4.7%) and 161(23.1%) were due to superficial and deep/organ SSI. On multivariate modelling, superficial and deep/organ SSI remained significant predictors of LOS (RR 1.14 and 1.61) and readmission (OR 2.99 and 6.90). Conclusion: While traditional measures such as biliary stenting and operative time drive superficial SSI, deep/ organ SSI are impacted by predictors more specific to anastomotic leak, contaminated field, and immunosuppression/metabolic syndrome. Our data demonstrates that prolonged LOS and readmissions are dominated by deep/ organ SSI, suggesting future strategies should focus on preferential prevention of deep/organ space infections.
DRG (Ref = No CC) CC
1.23
0.02
1.10 <0.01
3.07
<0.01
Major CC 1.26
0.03
1.14 0.01
4.59
<0.01
Other
<0.01
1.27 <0.01
5.59
<0.01
Moderate
1.19 <0.01
2.65
0.32
Major
1.36 <0.01
5.31
0.07
Extreme
2.49 <0.01
51.8
<0.01
1.66
SOI (Ref = Minor)
Center volume (Ref = Low) Medium
0.85
<0.01
High
0.68
<0.01
Surgeon volume (Ref = Low) Medium
0.95 <0.01
0.61
<0.01
High
0.94 0.01
0.61
<0.01
CC = comorbidities/complications, SOI = severity of illness.
MO 78 UNIQUE PREDICTORS OF SUPERFICIAL AND DEEP/ORGAN SPACE SURGICAL SITE INFECTIONS IN PANCREATECTOMY A. Fadayomi, G. Kasumova, O. Tabatabaie, S. de Geus, T. Kent, S. Ng, A. Moser, M. Callery, S. Ashley and J. Tseng Beth Israel Deaconess Medical Center, Boston, MA, USA Objective: Despite differences in etiology of superficial and deep/organ space infections, studies have grouped all SSIs together. We identified unique predictors for each SSI type and evaluated their effects on readmission and length of stay (LOS).
MO 79 GEOGRAPHIC REGION IS ASSOCIATED WITH TREATMENT AND SURVIVAL OUTCOMES FOR PANCREATIC CANCER A. Salami and A. Joshi Einstein Medical Center, Philadelphia, PA, USA Objective: We sought to assess the impact of geographic region on treatment characteristics and survival for pancreatic adenocarcinoma. Methods: The SEER registry was used to identify patients with potentially resectable pancreatic adenocarcinoma (AJCC IeIII) diagnosed between 2004 and 2013. The exposure of interest was geographic region of diagnosis: West (WE), South (SO) or North-East (NE). The endpoints of interest were: (1) recommendation of no surgery by the provider (2) utilization of resection and (3) disease-specific HPB 2017, 19 (S1), S40eS108