Association of center-level operative volume and acute outcomes following robotic-assisted colectomy for colorectal cancer.

Background: The adoption of robotic-assisted colectomy (RAC) remains limited due to high costs. There is a paucity of data regarding the impact of institutional robotic experience on costs in patients undergoing RAC for colorectal cancer.

Methods: All adult patients undergoing RAC for colorectal cancer were identified using the 2016-2020 Nationwide Readmissions Database.

Outcomes of Out-of-Hospital Cardiac Arrest at Centers With and Without On-Site Coronary Angiography: A Nationwide Analysis.

Background: The American Heart Association has advocated for regionalized systems of care for out-of-hospital cardiac arrest (OHCA), emphasizing admission to specialized centers with onsite coronary angiography. However, national data evaluating outcomes of OHCA admission to such centers remain limited.

Methods: Using the 2021 National Inpatient Sample, we identified all direct OHCA hospitalizations across US facilities.

Association of Mechanical Circulatory Support and Cardiac Catheterization Laboratory Procedural Volumes With Outcomes of Cardiogenic Shock.

Despite advancements in cardiogenic shock (CS) management, mortality remains high. While hospital volume has been linked to reduced mortality across myriad complex procedures, the cross-volume effects of mechanical circulatory support (MCS) and cardiac catheterization laboratory (CCL) procedures on CS patients not receiving these interventions remain unexplored. Using the 2016 to 2022 Nationwide Readmissions Database, we analyzed nonelective adult CS admissions at MCS- and CCL-capable hospitals.

Evaluation of the Timing to Noncardiac Surgery following Cardiac Operations: A National Analysis.

Background: Despite advancements in peri-operative care and conflicting evidence regarding the need for preoperative coronary revascularization, the optimal timing of noncardiac surgery (NCS) following cardiac operations remains unclear.

Objectives: The purpose of this study was to evaluate the effect of time interval between cardiac surgery and NCS on peri-operative risk of major adverse events (MAEs).

Methods: Adults undergoing elective CABG, valve repair or replacement, or combined procedures were identified in the 2016 to 2020 Nationwide Readmissions Database, with subsequent admission for NCS analyzed.

Examining safety of cardiac surgery in patients with preoperative cardiac arrest.

Background: Although postoperative cardiac arrest is a well-studied complication of cardiac surgery, few guidelines exist regarding timing of surgery in preoperative cardiac arrest (pCA). We examined the association between delayed timing of operation and postoperative outcomes following cardiac surgery in a large cohort of pCA.

Methods: Adults with a diagnosis of pCA undergoing a cardiac operation were identified in the 2016-2020 National Inpatient Sample.

Clinical Outcomes and Costs of Robotic-assisted vs Conventional Mitral Valve Repair: A National Analysis.

Background: Robotic approaches have been increasingly utilized for cardiothoracic operations, though concerns regarding costs remain. We evaluated short-term outcomes and costs of robotic-assisted and conventional mitral valve repair (MV-repair), hypothesizing that cost differences would be mitigated at high-volume programs.

Methods: Adults undergoing elective MV-repair from 2016 to 2020 were identified in the Nationwide Readmissions Database.

Timing of Noncardiac Surgery Following Transcatheter Aortic Valve Replacement: A National Analysis.

Background: The optimal timing of noncardiac surgery (NCS) following transcatheter aortic valve replacement (TAVR) for aortic stenosis has not been elucidated by current national guidelines.

Objectives: The aim of this study was to evaluate the effect of the time interval between TAVR and NCS (Δt) on the perioperative risk of major adverse events (MAEs).

Methods: All adult admissions for isolated TAVR for aortic stenosis were identified in the 2016 to 2020 Nationwide Readmissions Database.

National outcomes of expedited discharge following esophagectomy for malignancy.

Background: Expedited discharge following esophagectomy is controversial due to concerns for higher readmissions and financial burden. The present study aimed to evaluate the association of expedited discharge with hospitalization costs and unplanned readmissions following esophagectomy for malignant lesions.

Methods: Adults undergoing elective esophagectomy for cancer were identified in the 2014-2019 Nationwide Readmissions Database.

Short-term outcomes of bariatric surgery in patients with inflammatory bowel disease: a national analysis.

Background: While considered standard of care for obesity management, bariatric surgery is uncommon in patients with co-morbid inflammatory bowel disease (IBD).

Objectives: The present study aimed to assess the association of IBD with postoperative outcomes and resource use following bariatric surgery.

Setting: Academic, university-affiliated; United States.

Association of time to resection with survival in patients with colon cancer.

Purpose: Colon cancer (CC) remains a leading cause of cancer-related mortality worldwide, for which colectomy represents the standard of care. Yet, the impact of delayed resection on survival outcomes remains controversial. We assessed the association between time to surgery and 10-year survival in a national cohort of CC patients.

Association of body mass index with morbidity following elective ventral hernia repair.

Background: Prior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes.

Methods: Adults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program database.

Evaluation of hospital readmission rates as a quality metric in adult cardiac surgery.

Objective: To assess the reliability of 30-day non-elective readmissions as a quality metric for adult cardiac surgery.

Background: Unplanned readmissions is a quality metric for adult cardiac surgery. However, its reliability in benchmarking hospitals remains under-explored.

Acute clinical and financial outcomes of esophagectomy at safety-net hospitals in the United States.

Background: While safety-net hospitals (SNH) play a critical role in the care of underserved communities, they have been associated with inferior postoperative outcomes. This study evaluated the association of hospital safety-net status with clinical and financial outcomes following esophagectomy.

Methods: All adults (≥18 years) undergoing elective esophagectomy for benign and malignant gastroesophageal disease were identified in the 2010-2019 Nationwide Readmissions Database.

National Trends and Clinical Outcomes of Type B Aortic Dissection Management at Safety-Net Hospitals.

Introduction: Patients with type B aortic dissection (TBAD) are often underinsured and urgently admitted for open or thoracic endovascular aortic repair (TEVAR). The present study evaluated the association of safety-net status with outcomes among patients with TBAD.

Methods: The 2012-2019 National Inpatient Sample was queried to identify all adults admitted with type B aortic dissection.

Identifying the origin of socioeconomic disparities in outcomes of major elective operations.

Background: While the impact of socioeconomic status (SES) on surgical outcomes has been examined in limited series, it remains a significant determinant of healthcare outcomes at the national level. Therefore, the current study aims to determine SES disparities at three time-points: hospital accessibility, in-hospital outcomes, and post-discharge consequences.

Methods: The Nationwide Readmissions Database 2010-2018 was used to isolate major elective operations.

Association of hospital volume with conversion to open from minimally invasive colectomy in patients with diverticulitis: A national analysis.

Background: Despite the known advantages of minimally invasive surgery (MIS) for diverticular disease, the impact of conversions to open (CtO) colectomy remains understudied. The present study used a nationally representative database to characterize risk factors and outcomes associated with CtO in patients with diverticular disease.

Methods: All elective adult hospitalizations entailing colectomy for diverticulitis were identified in the 2017-2019 Nationwide Readmissions Database.

Thyroid surgery outcomes in octogenarians: A national analysis.

Background: The incidence of thyroid pathology increases with age. Yet octogenarians may face increased rates of complications after thyroid surgery. Using a nationally representative cohort, we evaluated the outcomes of thyroidectomy among octogenarians.

Association of Surgical Complications With Resource Utilization in Adult Congenital Cardiac Surgery.

Background: As patients with congenital heart disease are increasingly surviving well into adulthood, the morbidity, mortality, and resource utilization of adult congenital cardiac operations are of increasing interest. Therefore, we evaluated factors associated with perioperative morbidity and outcomes in adults undergoing congenital operations.

Methods: The Nationwide Readmissions Database was tabulated for all adults (≥18 years old) with congenital heart disease between 2010 and 2017.

National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations.

Background: Although the use of robotic-assisted surgery continues to expand, the cost-effectiveness of this platform remains unclear. The present study aimed to compare hospitalization costs and clinical outcomes between robotic-assisted surgery and laparoscopic approaches for major abdominal operations.

Methods: All adults receiving minimally invasive gastrectomy, cholecystectomy, colectomy (right, left, transverse, sigmoid), ventral hernia repair, hysterectomy, and abdominoperineal resection were identified in the 2012 to 2019 National Inpatient Sample.

National trends and clinical outcomes of interventional approaches following admission for infected necrotizing pancreatitis in the United States.

Background: With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large-scale studies are lacking, and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort.

Race, Insurance, and Sex-Based Disparities in Access to High-Volume Centers for Pancreatectomy.

Background: With a large body of literature demonstrating positive volume-outcome relationships for most major operations, minimum volume requirements have been suggested for concentration of cases to high-volume centers (HVCs). However, data are limited regarding disparities in access to these hospitals for pancreatectomy patients.

Methods: The 2005-2018 National Inpatient Sample (NIS) was queried for all elective adult hospitalizations for pancreatectomy.

Care Fragmentation After Hospitalization for Acute Myocardial Infarction.

Care fragmentation (CF), or readmission at a nonindex hospital, has been linked to inferior clinical and financial outcomes for patients. However, its impact on patients with acute myocardial infarction (AMI) is unclear. This study investigated the prevalence and impact of CF on the outcomes of patients with AMI.

Association of frailty with outcomes of resection for colonic volvulus: A national analysis.

Background: With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus.

Methods: Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010-2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes.

Major elective non-cardiac operations in adults with congenital heart disease.

Objective: To assess the impact of congenital heart disease (CHD) on resource utilisation and clinical outcomes in patients undergoing major elective non-cardiac operations.

Background: Due to advances in congenital cardiac management in recent years, more patients with CHD are living into adulthood and are requiring non-cardiac operations.

Methods: The 2010-2018 Nationwide Readmissions Database was used to identify all adults undergoing major elective operations (pneumonectomy, hepatectomy, hip replacement, pancreatectomy, abdominal aortic aneurysm repair, colectomy, gastrectomy and oesophagectomy).