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IN THE NEWS
GENERAL SURGERY NEWS / DECEMBER 2021
FIRST LOOK All articles by ETHAN COVEY
Cutting Hospital Stay May Increase Complications
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Focusing on shortening patients’ length of stay (LOS) following surgery may result in increased rates of postdischarge complications, according to a new study. “LOS has been used as a meaningful outcomes measure and as a potential target for quality improvement,” said Roujia D. Li, MD, of Northwestern University Surgical Outcomes and Quality Improvement Center, in Evanston, Ill. “One way is by introducing accelerated pathways to decrease LOS, such as an enhanced recovery protocol.” However, Dr. Roujia questioned whether a push toward shorter LOS has resulted in shifting complications to the post-discharge setting. To answer this question, Dr. Roujia and her colleagues set out to characterize changes in LOS and post-discharge complications over time, and to evaluate risk factors associated with post-discharge complications. Using data from the ACS National Surgical Quality Improvement Program (or NSQIP) Procedure-Targeted database, patients were identified who underwent colorectal, esophageal, hepato-pancreatico-biliary,
gynecologic and urologic surgery from 2014 to 2019. Among a total of 538,712 patients, median LOS decreased from three days in 2014 to two days in 2019. Additionally, overall postoperative complications, readmission rates, median LOS and mortality rates all decreased with time. In contrast, while rates of postoperative complications often fell, those for post-discharge complications did not. The proportion of postdischarge complications—including surgical site infection/wound dehiscence, infections such as pneumonia, urinary tract infection, sepsis, cardiovascular complications and venous thromboembolism— increased from 44.6% in 2014 to 56.5% during 2019. Patient characteristics associated with post-discharge complications included age, race/ethnicity, American Society of Anesthesiologists physical status class, functional status, body mass index and other comorbidities. “It is crucial to develop a patient monitoring program to focus on the early identification and management of post-discharge complications,” Dr. Roujia said.
Method of Communicating Risk Affects Patient Decision Making The way in which information about risks of treatments is communicated to patients can have a significant MISSION STATEMENT OF GSN It is the mission of General Surgery News to be an independent and reliable source of news and analysis about the current state of surgery. It strives to provide a venue for discussion and opinions, from all viewpoints, on the issues most important to surgeons.
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Senior Medical Adviser
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Editorial Advisory Board
Lauren A. Kosinski, MD Chestertown, MD
Gina Adrales, MD, MPH Baltimore, MD
Marina Kurian, MD New York, NY
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Frederick L. Greene, MD Charlotte, NC
The American College of Surgeons Clinical Congress
Peter K. Kim, MD Bronx, NY
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effect on their perceptions and decision making. “Surgeons must frequently communicate the probability of various treatment outcomes, complications and chances of cure to their patients to help them make health care decisions,” said Joshua Eli Rosen, MD, of the Surgical Outcomes Research Center at the University of Washington, in Seattle. “Prior studies have shown that how probability information is communicated can impact its interpretation and ultimately decisions that are made with it.” Yet, despite these concerns, no standard practice exists for how surgeons should communicate such information to their patients. To further study the effect of different communication approaches, an online survey was conducted that queried respondents on a set of complications associated with surgical and antibiotic treatment of appendicitis. Risk information was presented either verbally (i.e., “uncommon”), as quantitative point estimates (i.e., 3%), or via quantitative ranges (i.e., 1%-5%). Next, participants were asked to estimate the likelihood of a complication occurring for an average person with appendicitis. A total of 296 respondents completed the survey, with a mean age of 37 years. Verbal risk communications were found to result in significantly higher ranges of risk estimates for each surveyed complication, and were found to consistently lead to overestimation of risk. continued on page 6
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