K. D. Simmons1, R. L. Hoffman1, L. E. Kuo1, E. K. Bartlett1, D. N. Holena1, R. R. Kelz1 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction:
Studies of surgical outcomes can be confounded by operative complexity, one aspect of which is the performance of concurrent procedures. Complexity is difficult to assess from claims data due to the absence of established measures. However, surgical databases often include information on concurrent procedures. Thus, we hypothesized that the presence or absence of same-day procedures would be useful as a step toward including operative complexity in risk adjustment. Toward this end, we compared the association between concurrent procedures and surgical outcomes to examine the possible role for this information in risk adjustment and prediction.
Methods:
All records in which colon resection was performed at some point during inpatient admission were pulled from three state databases (California, Florida, and New York) between 2007 and 2012. Our primary outcome was in-hospital mortality; secondary outcomes were post-operative complications. For each outcome, we developed multivariate logistic regression model based on patient demographic, hospital, and admission characteristics; indications for colectomy; and the presence or absence of other procedures performed on the same day. Likelihood ratio tests were done to assess the effects of removing individual covariates on model fit.
Results:
We analyzed 209,508 colectomies, of which 40,787 (19.5%) were not performed on the same day as any other procedures. Overall mortality was 6.3%. Mortality was higher among patients with another procedure performed on the same day as colectomy (7.3%) than among patients for whom no other procedures were performed on the same day (2.2%, p<.001). In multivariate regression, having another same-day procedure was significantly associated with mortality (odds ratio 2.62, p<.001). Moreover, including this measure of complexity significantly improved the fit of the model (chi-squared = 895.98, p<.0001). The only covariates with greater contributions to adjusted mortality were age, number of comorbidities, colon cancer, and emergency admission. Similarly, same-day procedures were associated with higher complication rates, as shown in the table.
Conclusion:
The risk of complications and mortality following colon resection is increased among patients who have at least one other procedure on the same day. This measure may be underutilized as a source of variation in outcomes and may provide a window into operative complexity.
