Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways

Oliver S. Eng; Andrew M. Blakely; Kelly J. Lafaro; Keith F. Fournier; Nadege T. Fackche; Fabian M. Johnston; Sean Dineen; Benjamin Powers; Ryan Hendrix; Laura A. Lambert; Sean Ronnekleiv-Kelly; Kara Vande Walle; Travis E. Grotz; Jennifer L. Leiting; Sameer H. Patel; Vikrom K. Dhar; Joel M. Baumgartner; Andrew M. Lowy; Callisia N. Clarke; Harveshp Mogal; Mohammad Y. Zaidi; Charles A. Staley; Charles Kimbrough; Jordan M. Cloyd; Byrne Lee; Mustafa Raoof

doi:10.1002/jso.26099

Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways

Oliver S. Eng, Andrew M. Blakely, Kelly J. Lafaro, Keith F. Fournier, Nadege T. Fackche, Fabian M. Johnston, Sean Dineen, Benjamin Powers, Ryan Hendrix, Laura A. Lambert, Sean Ronnekleiv-Kelly, Kara Vande Walle, Travis E. Grotz, Jennifer L. Leiting, Sameer H. Patel, Vikrom K. Dhar, Joel M. Baumgartner, Andrew M. Lowy, Callisia N. Clarke, Harveshp MogalMohammad Y. Zaidi, Charles A. Staley, Charles Kimbrough, Jordan M. Cloyd, Byrne Lee, Mustafa Raoof

Surgical Oncology

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. Methods: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. Results: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P <.001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P <.001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. Conclusions: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.

Original language	English (US)
Pages (from-to)	980-985
Number of pages	6
Journal	Journal of surgical oncology
Volume	122
Issue number	5
DOIs	https://doi.org/10.1002/jso.26099
State	Published - Oct 1 2020

Keywords

ERAS
HIPEC
cytoreductive surgery
variation

ASJC Scopus subject areas

Surgery
Oncology

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10.1002/jso.26099

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Eng, O. S., Blakely, A. M., Lafaro, K. J., Fournier, K. F., Fackche, N. T., Johnston, F. M., Dineen, S., Powers, B., Hendrix, R., Lambert, L. A., Ronnekleiv-Kelly, S., Walle, K. V., Grotz, T. E., Leiting, J. L., Patel, S. H., Dhar, V. K., Baumgartner, J. M., Lowy, A. M., Clarke, C. N., ... Raoof, M. (2020). Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways. Journal of surgical oncology, 122(5), 980-985. https://doi.org/10.1002/jso.26099

Eng, OS, Blakely, AM, Lafaro, KJ, Fournier, KF, Fackche, NT, Johnston, FM, Dineen, S, Powers, B, Hendrix, R, Lambert, LA, Ronnekleiv-Kelly, S, Walle, KV, Grotz, TE, Leiting, JL, Patel, SH, Dhar, VK, Baumgartner, JM, Lowy, AM, Clarke, CN, Mogal, H, Zaidi, MY, Staley, CA, Kimbrough, C, Cloyd, JM, Lee, B & Raoof, M 2020, 'Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways', Journal of surgical oncology, vol. 122, no. 5, pp. 980-985. https://doi.org/10.1002/jso.26099

@article{3dff1a1ec77843d9ab0a3c1fd189edf4,

title = "Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways",

abstract = "Background: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. Methods: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. Results: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P <.001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P <.001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. Conclusions: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.",

keywords = "ERAS, HIPEC, cytoreductive surgery, variation",

author = "Eng, {Oliver S.} and Blakely, {Andrew M.} and Lafaro, {Kelly J.} and Fournier, {Keith F.} and Fackche, {Nadege T.} and Johnston, {Fabian M.} and Sean Dineen and Benjamin Powers and Ryan Hendrix and Lambert, {Laura A.} and Sean Ronnekleiv-Kelly and Walle, {Kara Vande} and Grotz, {Travis E.} and Leiting, {Jennifer L.} and Patel, {Sameer H.} and Dhar, {Vikrom K.} and Baumgartner, {Joel M.} and Lowy, {Andrew M.} and Clarke, {Callisia N.} and Harveshp Mogal and Zaidi, {Mohammad Y.} and Staley, {Charles A.} and Charles Kimbrough and Cloyd, {Jordan M.} and Byrne Lee and Mustafa Raoof",

note = "Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals LLC",

year = "2020",

month = oct,

day = "1",

doi = "10.1002/jso.26099",

language = "English (US)",

volume = "122",

pages = "980--985",

journal = "Journal of surgical oncology",

issn = "0022-4790",

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TY - JOUR

T1 - Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

T2 - An opportunity for enhanced recovery pathways

AU - Eng, Oliver S.

AU - Blakely, Andrew M.

AU - Lafaro, Kelly J.

AU - Fournier, Keith F.

AU - Fackche, Nadege T.

AU - Johnston, Fabian M.

AU - Dineen, Sean

AU - Powers, Benjamin

AU - Hendrix, Ryan

AU - Lambert, Laura A.

AU - Ronnekleiv-Kelly, Sean

AU - Walle, Kara Vande

AU - Grotz, Travis E.

AU - Leiting, Jennifer L.

AU - Patel, Sameer H.

AU - Dhar, Vikrom K.

AU - Baumgartner, Joel M.

AU - Lowy, Andrew M.

AU - Clarke, Callisia N.

AU - Mogal, Harveshp

AU - Zaidi, Mohammad Y.

AU - Staley, Charles A.

AU - Kimbrough, Charles

AU - Cloyd, Jordan M.

AU - Lee, Byrne

AU - Raoof, Mustafa

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Background: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. Methods: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. Results: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P <.001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P <.001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. Conclusions: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.

AB - Background: Variations in care have been demonstrated both within and among institutions in many clinical settings. By standardizing perioperative practices, Enhanced Recovery After Surgery (ERAS) pathways reduce variation in perioperative care. We sought to characterize the variation in cytoreductive surgery (CRS)/heated intraperitoneal chemotherapy (HIPEC) perioperative practices among experienced US medical centers. Methods: Data from the US HIPEC Collaborative represents a retrospective multi-institutional cohort study of CRS and CRS/HIPEC procedures performed from 12 major academic institutions. Patient characteristics and perioperative practices were reported and compared. Institutional variation was analyzed using hierarchical mixed-effects linear (continuous outcomes) or logistic (binary outcomes) regression models. Results: A total of 2372 operations were included. CRS/HIPEC was performed most commonly for appendiceal histologies (64.2%). The rate of complications (overall 56.3%, range: 31.8-70.9) and readmissions (overall 20.6%, range: 8.9-33.3) varied by institution (P <.001). Institution-level variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes (P <.001). The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6% to 66.6%. Conclusions: Significant variation exists in the perioperative care of patients undergoing CRS/HIPEC at major US academic institutions. These findings provide a strong rationale for the investigation of best practices in CRS/HIPEC patients.

KW - ERAS

KW - HIPEC

KW - cytoreductive surgery

KW - variation

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DO - 10.1002/jso.26099

M3 - Article

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SN - 0022-4790

VL - 122

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JO - Journal of surgical oncology

JF - Journal of surgical oncology

IS - 5

ER -

Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways

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