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The objective of the current study was to assess the impact of case mix index at the hospital level on postoperative outcomes among Medicare beneficiaries who underwent hepatopancreatic surgery. Medicare beneficiaries who underwent hepatopancreatic surgery between 2013 and 2017 were identified and analyzed. The primary independent variable, Case Mix Index, is a freely available metric; the primary outcome was textbook outcome defined as the absence of complications, extended length of stay, readmission, and mortality. Among 37,412 Medicare beneficiaries, 64.9% (n = 24,299) underwent a pancreatectomy and 35.1% (n = 13,113) underwent hepatectomy. The overall incidence of textbook outcome was 47.2%, which varied by case mix index (low case mix index: 41.6% vs high case mix index: 51.3%), as did extended length of stay (low case mix index: 27.9% versus high case mix index: 19.3%), complications (low case mix index: 33.3% vs high case mix index: 24.7%), and 90-day mortality (low case mix index: 12.5% vs high case mix index: 6.3%). After controlling for hepatopancreatic-specific surgical volume and hospital teaching status, multivariable analyses revealed that patients who underwent surgery at a low case mix index hospital had 28% decreased odds (95% confidence interval 0.66–0.79) of achieving a textbook outcome versus patients from a high case mix index hospital. Moreover, patients at a low case mix index hospital had 39% increased odds of extended length of stay (95% confidence interval 1.23–1.59), 48% increased odds of experiencing a complication (95% confidence interval 1.32–1.65), and 56% increased odds of 90-day mortality (95% confidence interval 1.31–1.87). Case mix index was strongly associated with the probability of achieving a textbook outcome after hepatopancreatic surgery. Hospitals with a higher case mix index were more likely to perform hepatopancreatic surgeries with no adverse postoperative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The impact of metabolic syndrome (MetS) on postoperative outcomes following liver surgery is not well studied. The objective of the current study was to examine the association of MetS with individual perioperative outcomes, as well as the composite "textbook outcome" (TO) following liver resection for both benign and malignant indications. Methods: The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent hepatectomy between 2013 and 2017. The impact of MetS on complications, length of stay (LOS), 90-day readmission, 90-day mortality, and TO following hepatectomy was investigated. Results: Among 13,898 patients who underwent hepatectomy, 2491 (17.9%) had MetS while 11,407 (82.1%) did not. Patients with MetS were more often male (59.1% vs 48.5%), Black (8.5% vs 6.6%), and had a diagnosis of cancer (69.9% vs 65.1%) (all p<0.001). On multivariable analysis, patients with MetS had higher odds of complications (OR 1.41, 95% CI 1.28–1.55), 90-day readmission (OR 1.27, 95% CI 1.15–1.40), and 90-day mortality (OR 1.32, 95% CI 1.13–1.54). In turn, patients with MetS had markedly lower odds of TO following hepatectomy compared with non-MetS patients (OR=0.76, 95% CI 0.70–0.83). Of note, patients with MetS had lower odds of TO after both minimally invasive (OR=0.59, 95% CI 0.43–0.81) and open (OR=0.75, 95% CI 0.68–0.82) liver surgery. Individuals with MetS also had a higher overall expenditure during the index hospitalization compared with non-MetS patients ($19.9k USD vs. $18.8k USD, p<0.001). Conclusion: Patients with MetS had increased morbidity and mortality, as well as lower likelihood to achieve a TO following liver resection. MetS increased the operative risk and overall Medicare expenditures associated with hepatic resection. [ABSTRACT FROM AUTHOR]

We sought to examine patient- and disease-related factors that influenced patient decisions to refuse surgery for an early-stage HPB cancer. Keywords: Liver; Pancreas; Hepatocellular carcinoma; Cholangiocarcinoma; Refusal; Resection EN Liver Pancreas Hepatocellular carcinoma Cholangiocarcinoma Refusal Resection 1573 1575 3 06/16/21 20210601 NES 210601 Rayyan S. Mirdad and Diamantis I. Tsilimigras contributed equally as first authors Introduction Although surgery offers the best chance for long-term survival, previous research has demonstrated a large variation in utilization of surgery among patients with resectable hepato-pancreato-biliary (HPB) malignancies.[1],[2] Despite resection being technically feasible, a subset of patients will elect not to proceed with surgery against the recommendations of their treating physician.[3] Understanding the factors underlying refusal of surgery can help develop strategies to increase surgical utilization, improve shared decision-making, and optimize patient outcomes. Massa et al. similarly noted that patients who refused surgery for laryngeal cancer had a worse 5-year survival.[6] The authors also noted that patients without marital support were more likely to refuse surgery. [Extracted from the article]

Background: The effect of community-level factors on surgical outcomes has not been well examined. We sought to characterize differences in "textbook outcomes" (TO) relative to social vulnerability among Medicare beneficiaries who underwent operations for cancer.Methods: Individuals who underwent operations for lung, esophageal, colon, or rectal cancer between 2013 and 2017 were identified using the Medicare database, which was merged with the CDC's Social Vulnerability Index (SVI). TO was defined as surgical episodes with the absence of complications, extended length of stay, readmission, and mortality. The association of SVI and TO was assessed using mixed-effects logistic regression.Results: Among 203,800 patients (colon, n = 113,929; lung, n = 70,642; rectal, n = 14,849; and esophageal, n = 4,380), median age was 75 years (interquartile range 70 to 80 years) and the overwhelming majority of patients was White (n = 184,989 [90.8%]). The overall incidence of TO was 56.1% (n = 114,393). The incidence of complications (low SVI: 21.5% vs high SVI: 24.0%) and 90-day mortality (low SVI: 7.0% vs high SVI: 8.4%) were higher among patients from highly vulnerable neighborhoods (both, p < 0.05). In turn, there were lower odds of achieving TO among high-vs low-SVI patients (odds ratio 0.83; 95% CI, 0.78 to 0.87). Although high-SVI White patients had 10% lower odds (95% CI, 0.87 to 0.93) of achieving TO, high-SVI non-White patients were at 22% lower odds (95% CI, 0.71 to 0.85) of postoperative TO. Compared with low-SVI White patients, high-SVI minority patients had 47% increased odds of an extended length of stay, 40% increased odds of a complication, and 23% increased odds of 90-day mortality (all, p < 0.05).Conclusions: Only roughly one-half of Medicare beneficiaries achieved the composite optimal TO quality metric. Social vulnerability was associated with lower attainment of TO and an increased risk of adverse postoperative surgical outcomes after several common oncologic procedures. The effect of high SVI was most pronounced among minority patients. [ABSTRACT FROM AUTHOR]