Chelsey Meise

American College of Surgeons NSQIP: quality in-training initiative pilot study.

BACKGROUND Clinical outcomes data are playing an increasingly important role in medical decision-making, reimbursement, and provider evaluation, but there are no documented programs that provide outcomes data to surgical residents as part of a structured curriculum. Our objectives were to develop a national collaborative of training programs to unify the efforts between quality and education personnel and demonstrate the feasibility of generating customized reports of patient outcomes for use in surgical education. STUDY DESIGN The pool of potential hospitals was evaluated by comparing ACS NSQIP participants with the roster of clinical sites for general surgery residency programs maintained by FREIDA Online. A program and user guide was developed to generate custom reports based on institutional data, and a voluntary pilot was conducted, consisting of initial development, implementation, and feedback stages. Programs that successfully completed installation and report generation were queried for feedback on time and resources used. RESULTS Of 245 general surgery residency programs, 47% had a NSQIP-affiliated sponsor institution, and an additional 31% had at least 1 NSQIP-affiliated participant institution. Sixty general surgery residency programs have expressed interest in collaboration. Seventeen pilot sites completed training and installation, and were able to independently generate custom reports. The response rate for the post-report survey was 50%. Participants reported that training and installation typically required one 2-hour phone call, and that total time devoted to the project was less than 8 hours. CONCLUSIONS Collaboration between educators and quality improvement personnel from a diverse group of organizations to integrate outcomes data into surgical education is feasible. Obtaining resident and team reports from ACS NSQIP can be done with minimal effort. Future efforts will be aimed at developing a national data-centered curriculum for general surgery programs.

Preoperative radiation for retroperitoneal sarcoma is not associated with increased early postoperative morbidity

Preoperative radiation (PR) in the management of retroperitoneal sarcoma (RPS) is controversial. Concern for increased perioperative morbidity may influence the decision to recommend PR. Here we compare 30‐day morbidity and mortality (M + M) after resection of RPS with and without PR.

Sartorius transposition during inguinal lymphadenectomy for melanoma

BACKGROUND Inguinal lymph node dissection (ILND) for melanoma has been associated with high rates of wound complication (WC). Sartorius transposition (ST) is a technique that has been proposed to minimize morbidity. We report the frequency of utilization of ST and associated clinical outcomes in a national sample. MATERIALS AND METHODS Patients undergoing ILND for melanoma were identified in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2005-2011). ST status was determined. Univariate logistic regression analyses were performed. Propensity score matching was used to control for operative time. Conditional logistic regression was used to determine the likelihood of a WC following ST in the matched cohort. RESULTS Of the 381 patients identified, 13% had a WC. By univariate analysis, increasing body mass index (P = 0.006), diabetes (P = 0.02), and longer operative time (P = 0.005) were associated with WC. Sixty-three patients received a prophylactic ST (16.5%). ST use was significantly associated with deep nodal dissection (P = 0.03) and increased operative time (P < 0.0001) but not with any preoperative risk factors. WC rates were similar between ST and non-ST patients (10% versus 14%, P = 0.39). In the multivariate analysis of patients matched for operative time, ST was the only factor significantly associated with lower WC rate. The WC rate was 23% in non-ST compared with 8% in ST patients (P = 0.05). CONCLUSIONS Nationally, ST is used infrequently at the time of ILND. Moreover, patients undergoing ST do not appear to be selected based on the patient factors associated with increased risk of WC. Risk factors for wound complication should be considered in the selective use of ST.

Racial disparities in the use of outpatient mastectomy.

BACKGROUND Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race. METHODS We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007-2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders. RESULTS We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P < 0.001). After adjustment for multiple confounders, black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93; OR, 0.55; 95% CI, 0.41-0.72; and OR, 0.70; 95% CI, 0.64-0.76, respectively) compared with white patients. CONCLUSIONS Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use.