Risk-adjusted rates for potentially avoidable reoperations were computed from routine hospital data

Abstract

OBJECTIVES: Reoperations may reflect a suboptimal initial surgical treatment. The study aimed to develop a screening algorithm for those potentially avoidable, using only routinely collected hospital data and a prediction model to adjust rates for case-mix. STUDY DESIGN AND SETTING: Data of a 3-year random sample of 7,370 therapeutic operations on inpatients, among which 833 were followed-up by a reoperation during the same stay. A review of medical records identified clearly avoidable and other potentially avoidable reoperations to develop and test the screening algorithm. A logistic prediction model of potentially avoidable reoperations was developed on one randomly chosen half of the data (about 9,000 interventions) and tested on the other half (cross-validation). RESULTS: Two hundred thirty-seven interventions (3%) were followed by a potentially avoidable reoperation, among which 144 were clearly avoidable. The screening algorithm had a sensitivity of 75% and a specificity of 72%. Predictors of potentially avoidable reoperations were surgery categories, diagnosis related conditions, and experiencing prior surgery. The risk score, based on these variables, showed at once a satisfactory discriminative performance (C-statistic=0.76) and goodness-of-fit measure on the validation set. CONCLUSION: The adjusted rate of potentially avoidable reoperations should be included in internal reporting of hospital quality indicators, but further validated in various settings. [Authors]]]> Hospitals ; Medical Errors ; Quality Indicators, Health Care ; Reoperation eng oai:serval.unil.ch:BIB_648CC6EA31FA 2025-08-02T01:31:06Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_648CC6EA31FA Hemicolectomy versus appendectomy for patients with appendiceal neuroendocrine tumours 1-2 cm in size: a retrospective, Europe-wide, pooled cohort study. info:doi:10.1016/S1470-2045(22)00750-1 info:eu-repo/semantics/altIdentifier/doi/10.1016/S1470-2045(22)00750-1 info:eu-repo/semantics/altIdentifier/pmid/36640790 Nesti, C. Bräutigam, K. Benavent, M. Bernal, L. Boharoon, H. Botling, J. Bouroumeau, A. Brcic, I. Brunner, M. Cadiot, G. Camara, M. Christ, E. Clerici, T. Clift, A.K. Clouston, H. Cobianchi, L. Ćwikła, J.B. Daskalakis, K. Frilling, A. Garcia-Carbonero, R. Grozinsky-Glasberg, S. Hernando, J. Hervieu, V. Hofland, J. Holmager, P. Inzani, F. Jann, H. Jimenez-Fonseca, P. Kaçmaz, E. Kaemmerer, D. Kaltsas, G. Klimacek, B. Knigge, U. Kolasińska-Ćwikła, A. Kolb, W. Kos-Kudła, B. Kunze, C.A. Landolfi, S. La Rosa, S. López, C.L. Lorenz, K. Matter, M. Mazal, P. Mestre-Alagarda, C. Del Burgo, P.M. van Dijkum, EJMN Oleinikov, K. Orci, L.A. Panzuto, F. Pavel, M. Perrier, M. Reims, H.M. Rindi, G. Rinke, A. Rinzivillo, M. Sagaert, X. Satiroglu, I. Selberherr, A. Siebenhüner, A.R. Tesselaar, MET Thalhammer, M.J. Thiis-Evensen, E. Toumpanakis, C. Vandamme, T. van den Berg, J.G. Vanoli, A. van Velthuysen, M.F. Verslype, C. Vorburger, S.A. Lugli, A. Ramage, J. Zwahlen, M. Perren, A. Kaderli, R.M. info:eu-repo/semantics/article article 2023-02 The Lancet. Oncology, vol. 24, no. 2, pp. 187-194 info:eu-repo/semantics/altIdentifier/eissn/1474-5488 urn:issn:1470-2045 <![CDATA[Awareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1-2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1-2 cm in size in patients with or without right-sided hemicolectomy. In this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1-2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693. 282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1-2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0-15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 -21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36-2·17]; p=0·71). This study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1-2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort. Swiss Cancer Research foundation