Adrienne N. Cobb

Commercial quality “awards” are not a strong indicator of quality surgical care

Background: This study aimed to determine whether publicized hospital rankings can be used to predict surgical outcomes. Methods: Patients undergoing one of nine surgical procedures were identified, using the Healthcare Cost and Utilization Project State Inpatient Database for Florida and New York 2011–2013 and merged with hospital data from the American Hospital Association Annual Survey. Nine quality designations were analyzed as possible predictors of inpatient mortality and postoperative complications, using logistic regression, decision trees, and support vector machines. Results: We identified 229,657 patients within 177 hospitals. Decision trees were the highest performing machine learning algorithm for predicting inpatient mortality and postoperative complications (accuracy 0.83, P<.001). The top 3 variables associated with low surgical mortality (relative impact) were Hospital Compare (42), total procedure volume (16) and, Joint Commission (12). When analyzed separately for each individual procedure, hospital quality awards were not predictors of postoperative complications for 7 of the 9 studied procedures. However, when grouping together procedures with a volume‐outcome relationship, hospital ranking becomes a significant predictor of postoperative complications. Conclusion: Hospital quality rankings are not a reliable indicator of quality for all surgical procedures. Hospital and provider quality must be evaluated with an emphasis on creating consistent, reliable, and accurate measures of quality that translate to improved patient outcomes.

Predicting burn patient mortality with electronic medical records

Background: Although there exists robust literature on mortality‐associated factors in burn patients, it is not known how electronic medical records affect outcomes. Using burn injury as a surgical care model of information and communication, we hypothesized that functionality and interoperability of the electronic medical record could serve as determinants of outcome. Methods: We used the state inpatient databases for New York, Washington, California, and Florida for the years 2009 and 2010 for all states, with the additional years of 2012 and 2013 for New York (n=6,002), and the respective data from the American Hospital Association Information Technology survey. Using International Classification of Diseases, Ninth Revision, codes, we included burn patients and characterized total body surface area burned. We summed the binary answers to questions 1 and 2 and question 3 from the American Hospital Association Information Technology survey to make continuous functionality and interoperability scores. Mortality was predicted using extreme gradient boosting in Python. Results: In each state in which our models had an accuracy and area under the curve of more than 0.90, electronic medical record functionality but not interoperability was a significant predictor in New York, California, and Florida. Important predictors in each state were, age, duration of stay, total body surface area burned/severity, and total charges. Electronic medical record functionality was more important than all comorbidities except for coagulopathies and electrolyte disorders. Higher functionality scores were associated with mortality (P < .01). Conclusion: Our data support our hypothesis that electronic medical records may be associated with mortality in burn patients; however, electronic medical records are not having the intended impact on outcomes, and further research needs to elucidate exactly how electronic medical records are being used in clinical settings.

Abstract P1-10-04: Post-operative imaging after atypical ductal hyperplasia excision: The findings and costs

Introduction: With a reported incidence of 2-12% in breast biopsy specimens, the appropriate management of atypical ductal hyperplasia (ADH) remains in evolution. At present, the optimal screening guidelines for patients with high-risk breast lesions such as ADH remain unclear. Current practices often parallel the surveillance of cancer patients and include a 6 month interval mammogram prior to resuming annual screening, which may result in unnecessary procedures and financial costs. This interval mammogram is typically a diagnostic study, which is an additional cost to the patient and healthcare system. The purpose of this study was to identify interval pathology following initial surgical resection and review associated costs. Methods: Following institutional review board approval, the pathology database from a single institution was queried for patients who underwent surgical excision for ‘atypical ductal hyperplasia’ from 2008 to 2013. Those who did not have follow-up data available were excluded. Subsequent clinical care was reviewed, including interval imaging and need for additional intervention. Based on a review of hospital charges from 2013, the average charge for a unilateral diagnostic mammogram (out-patient, digital) was

Carotid Body Tumor Resection: Just as Safe without Preoperative Embolization

382. Results: There were 55 patients who underwent an excisional biopsy that were diagnosed with ADH and had subsequent follow-up. The median age was 57 years (range 38-82 years), and the median breast cancer risk assessment score was 2.3% at 5 years (range 0.5-17.9%) and 12.5% lifetime risk (range 2.2-37.6%). Pathology included concurrent lobular carcinoma in situ (n=1), atypical lobular hyperplasia (n=3), flat epithelial atypia (n=14), and papillary lesions (n=19). In addition to a routine clinical breast exam, a short-term follow-up diagnostic (ipsilateral) mammogram was performed in 35 patients. Of the 35 interval mammograms obtained, 31 yielded benign findings on initial imaging, while 4 patients required additional imaging that ultimately resulted in benign findings. The overall hospital charges for the 35 short interval mammograms alone during this 6 year period were roughly

Alcohol enhances symptoms and propensity for infection in inflammatory bowel disease patients and a murine model of DSS‐induced colitis

13,370. For the patients that resumed annual surveillance, 3 had abnormal mammograms requiring additional imaging, and no malignancies were identified in this subset of patients. To date, the median physician follow-up is 3 years, and 52 patients have undergone at least one mammogram since their initial imaging; all subsequent findings have been benign for all patients. When extrapolated to national data, cost savings to the healthcare system from eliminating short interval mammograms would exceed

Seeing the forest beyond the trees: Predicting survival in burn patients with machine learning

12 million annually without compromising clinical outcomes. Conclusions: Based on our findings, a 6 month follow-up mammogram is not recommended and incurs unnecessary costs to the patient and healthcare system. In the post-surgical breast, imaging may be misleading and result in additional procedures and significant charges that ultimately do not affect clinical outcomes. Although a clinical exam is still recommended at 6 months following surgical excision for a diagnosis of ADH, patients should forego short interval (6 month) imaging and resume annual mammogram surveillance. Citation Format: Jennifer K Plichta, Adrienne N Cobb, Gerard J Abood, Constantine Godellas, Claudia B Perez. Post-operative imaging after atypical ductal hyperplasia excision: The findings and costs [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-10-04.