University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Res. 2021 Aug;264:8-15. doi: 10.1016/j.jss.2021.01.044. Epub 2021 Mar 18.
At the patient level, optimizing risk factors before surgery is a proven approach to improve patient outcomes after hernia repair. However, nearly 25% of patients are not adequately optimized before surgery. It is currently unknown how surgeon-level adherence to preoperative optimization impacts postoperative outcomes. In this context, we evaluated the association between surgeon adherence to optimization practices and surgeon-level postoperative outcomes.
Michigan Surgical Quality Collaborative data from 2014 to 2018 was analyzed to examine rates of surgeon adherence to preoperative optimization when performing elective ventral and incisional hernia repair. Adherence was defined as operating on patients who were nontobacco users with a body mass index >18.5 kg/m2 and <40 kg/m2. Surgeons were assigned a risk- and reliability-adjusted adherence rate which was used to divide surgeons into tertiles. Outcomes were compared between adherence tertiles.
Across 70 hospitals in Michigan, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Surgeon adherence to preoperative optimization ranged from 51% to 76%. Surgeons in the lowest optimization tertile had higher rates of emergency department visits (8.78% versus 7.05% versus 7.03%, P < 0.001), serious complications (2.12% versus 1.56% versus 1.84%, P = 0.041), and any complication (4.08% versus 3.37% versus 4.04%, P = 0.043), than middle and high optimization tertiles.
Surgeons' clinical outcomes, including complication rates, are affected by the proportion of their patients who are preoperatively optimized with regard to obesity and tobacco use. These results suggest that surgeons can improve their postoperative outcomes by addressing these issues before surgery.
在患者层面上，优化手术前的风险因素是改善疝修补术后患者结局的一种已被证实的方法。然而，近 25%的患者在手术前未得到充分优化。目前尚不清楚外科医生对术前优化的依从性如何影响术后结局。在这种情况下，我们评估了外科医生对优化实践的依从性与外科医生层面术后结局之间的关联。
分析了 2014 年至 2018 年密歇根外科质量协作的数据，以检查在进行择期腹侧和切口疝修补时外科医生对术前优化的依从率。依从性定义为对非吸烟且体重指数（BMI）>18.5kg/m2 且<40kg/m2 的患者进行手术。为外科医生分配了风险和可靠性调整后的依从率，该率用于将外科医生分为三分位。在依从三分位组之间比较结局。
在密歇根州的 70 家医院中，有 15016 名患者接受了腹侧和切口疝修补术，由 454 名外科医生治疗。外科医生对术前优化的依从率从 51%到 76%不等。在最低优化三分位的外科医生中，急诊就诊率较高（8.78%比 7.05%比 7.03%，P<0.001）、严重并发症发生率较高（2.12%比 1.56%比 1.84%，P=0.041）和任何并发症发生率较高（4.08%比 3.37%比 4.04%，P=0.043），而中间和高优化三分位的外科医生则较低。
外科医生的临床结局，包括并发症发生率，受到肥胖和吸烟方面术前优化患者比例的影响。这些结果表明，外科医生可以通过在手术前解决这些问题来改善他们的术后结局。
