John P Kuckelman, DO, John M McClellan, MD, Jason Bingham, MD, Douglas Stoddard, MD, MBA, Vance Sohn, MD. Madigan Army Medical Center
Introduction: A growing body of literature suggests that high-volume centers have better outcomes and lower complication rates in major oncological procedures. However, no Department of Defense (DoD) facility meets the high-volume threshold and yet performs these resections. The goal of this analysis was to determine differences in 30 day outcomes for major oncologic resections using the NSQIP database.
Methods: Using the NSQIP database, we extracted 30 day outcome data for all post-operative recurrences in four major index procedures: colectomy, pancreatectomy, hepatectomy, and esophagectomy.
Results: From January 2010 to April 2014, there were a total of 1,338 DoD and 266,654 civilian cases. Within this group, 434 DoD patients and 89,069 civilian patients experienced a post-operative occurrence (32.4% vs. 33.4%). The demographics and pre-operative health of both the DoD and civilian patient populations were similar in all four surgical groups. Post-operatively, DoD hospitals reported more readmissions within 30 days (23.5% vs. 21.9%) and unplanned reoperations (23.3% and 14.1%), but, overall, the DoD had less mortality within 30 days (8.8% vs. 9.9%). Both have a similar mean number of post-op occurrences (1.7 DoD vs. 1.8 civilian), 45% of those being wound complications in DoD group vs. 42% in the civilian population. However, patients undergoing surgery within the DoD did have significantly less post-op sepsis rates (13.1% vs. 20.4%).
Conclusions: In modern outcomes-based medicine, our data suggests that many oncological procedures can be safely performed at low volume, DoD hospitals, with overall similar morbidity and less mortality than civilian hospitals.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79450
Program Number: MSS02
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium