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Suitability of ACS-NSQIP as a Quality-Measurement Tool for Advanced Cancer Patients
*Roberto J. Vidri, *Shreyus S. Kulkarni, *Raj G. Vaghjiani, William G. Cioffi, *Daithi S. Heffernan, Thomas J. Miner
Brown University, Providence, RI
Objective:
Surgical quality, and potentially reimbursement rates, is often judged by postoperative mortality. Many authors propose using ACS-NSQIP in the development of risk calculators and as aid for clinical decision-making. Palliative operations may play invaluable roles in patients with advanced cancer. Palliative patients, however, may live longer than the 30 days captured by ACS-NSQIP. We therefore evaluated the suitability of ACS-NSQIP database in risk-calculation and operative decision making in the advanced cancer patient population.
Design:
Six-year retrospective review of a single institution’s NSQIP database for cases identified as “Disseminated Cancer” to recognize procedures performed with palliative intent. Kaplan-Meier was used for survival analysis.
Setting:
Academic, tertiary care center
Patients:
Disseminated Cancer patients within ACS-NSQIP
Interventions:
None
Main Outcome Measures:
Post-operative mortality
Results:
From the 7,764 patients in NSQIP, 138 were identified as “Disseminated Cancer”. Thirty-day mortality was higher in this “Disseminated Cancer” group compared with all other surgical patients (8.7% versus 1.1%; p<0.001). Following explicit chart review of the 138 disseminated cancer patients, 32 patients had undergone palliative operations. Comparing palliative to non-palliative patients, 30-day mortality was no different (12.5% versus 7.5%, p=0.47). However, a significant difference existed at 45 days (34.4% versus 10.4%, p=0.004), 60 days (40.6% versus 13.2%, p=0.001), and 90 days (46.9% versus 14.2%, p<0.001) after the procedure.
Conclusions:
Consistent with known data, patients with disseminated cancer have increased post-operative mortality. When comparing palliative to non-palliative operations, our NSQIP data shows similar 30-day mortality. However, a significant mortality difference is evident beyond the 30-day time limit captured by NSQIP. We demonstrate that in patients with advanced cancer, ACS-NSQIP has significant limitations as a decision making tool, especially with respect to palliative operations.
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