Maria Altieri, Jie Yang, MD, Donglei Yin, MD, Patrick Jasinsky, MD, Kristen Cagino, MD, Mark Talamini, MD, Aurora Pryor, MD. Stony Brook Medical Center
There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. Little is known regarding outcomes comparing facility type (academic versus non-academic). The purpose of our study is to examine if facility type has any impact on complications, 30-day and 1-year readmission and emergency department (ED) visit, and length of stay for patients undergoing HPB surgeries.
The SPARCS administrative database was used to identify all patients undergoing complex HPB procedures between 2012-2014. CPT and ICD-9 codes were used to identify procedures. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication, 30-day and 1-year readmission and ED-visits, and possible risk factors. Linear mixed models were used to estimate the marginal association between possible risk factors and length of stay. Facility type, as well as variables which were significant in the univariate analysis at a significance level of 0.05 were further included in the multivariable regression models.
There were 4,122 complex HPB procedures performed, with 1,403 (34%) in 2012, 1356 (33.9%) in 2013, and 1363 (33.1%) in 2014. Male patients were more likely to go to academic facilities (p=0.04). In addition, patients differed in terms of age, race, region, insurance (p<0.01). Academic facilities were more likely to have a higher hospital volume (p<0.001). Patients who underwent procedures at a non-academic facility were more likely to have comorbidities (P =0.0114), although patients at academic facilities were more associated with metastatic cancer and liver disease (p<0.001 and 0.03, respectively). Marginally, patients at non-academic facilities were more likely to have any complication or severe complications compared to those at academic facilities (p<0.001 and 0.0018, respectively). In terms of severe complications, patients at non-academic facilities had a higher rate of prolonged ventilation (p=0.0484), cardiac arrest (p=0.0492), sepsis (p=0.0218), and hemorrhage (p=0.0233). However, after adjusting for possible confounding factors, patients from academic facilities and nonacademic facilities had no significant difference in risk of severe complications. No significant difference was found between academic and non-academic facilities in terms of readmission, ED visit, and length of stay. After adjusting for possible confounding factors, patients from academic facilities were more likely to have 30-day readmission.
Our study found that there were no significant differences in outcomes between academic and non-academic facilities after adjusting for age, gender, race, region, insurance and hospital volume. However, patients from academic facilities were more likely to have 30-day readmission.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79855
Program Number: S083
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel