The impact of complication-sensitive risk models on hospital benchmarking for failure to rescue.

Background: Failure to rescue has been increasingly used as a surgical quality metric, although implementation with complication-agnostic risk models may disproportionately penalize centers that care for high-risk patients. We used a nationally representative database to assess the impact of complication-sensitive risk models on hospital benchmarking for failure to rescue.

Methods: All adults undergoing elective coronary artery bypass grafting, aortic/mitral valve replacement, or esophageal/pancreatic/large bowel resection were identified within the 2019 Nationwide Readmissions Database.

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.

Temporal trends in the utilization, costs, and outcomes of concomitant left atrial appendage closure across a statewide collaborative.

Objective: With the rising incidence of atrial fibrillation, left atrial appendage closure (LAAC) at the time of cardiac surgery remains an important adjunct. The present study characterized trends, associated resource utilization, and potential disparities in the use of left atrial appendage exclusion.

Methods: Using a Society of Thoracic Surgeons regional academic collaborative database, we queried all adult patients undergoing coronary and valve procedures with concomitant LAAC between 2015 and 2021.

Implementation of a Multidisciplinary Team for Initiation of Extracorporeal Cardiopulmonary Resuscitation in Patients Presenting After Out-of-hospital Cardiac Arrest.

Objectives: Patents with out-of-hospital cardiac arrest (OHCA) are at high risk of death or poor neurologic recovery if spontaneous circulation is not rapidly restored. Emergent mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of extracorporeal cardiopulmonary resuscitation (ECPR) offers a bridge to diagnostic and therapeutic interventions but can be challenging to provide in a timely fashion. Coordination of multidisciplinary institutional resources into an ECMO Shock Team (ECMO-ST) may improve the survival of ECPR patients while concurrently increasing the number of OHCA patients placed on ECMO.

Meconium-Related Obstruction and Clinical Outcomes in Term and Preterm Infants.

Importance: Textbooks attribute 80% of meconium-related small bowel obstructions to cystic fibrosis and 15% of colonic obstructions to Hirschsprung disease. It is unknown whether these estimates are accurate, particularly among preterm infants, whose immature bowel predisposes them to meconium-related obstruction (MRO).

Objective: To estimate the incidence of MRO by type and to assess its association with clinical outcomes.

Association of Coronary Revascularization Modality and Timing With Outcomes of Acute Coronary Syndrome in Kidney Transplant Recipients.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality among renal transplant (RTx) recipients, with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) representing a disproportionately high burden. However, the optimal revascularization strategy for NSTE-ACS in RTx recipients remains unclear. This retrospective study analyzed the 2016 to 2021 Nationwide Readmissions Database.

National Trends in Hospital Admissions, Interventions and Outcomes for Early-Onset (Age <50) Diverticulitis From 2005-2020.

Background: Little is known about the burden and outcomes of diverticulitis in patients under the age of 50. This knowledge gap hinders the development of effective management strategies and preventive measures for this population.

Objective: This study aimed to analyze national trends in hospitalizations, interventions, and outcomes for early-onset (age <50) diverticulitis in comparison to standard-onset (age ≥50) cohorts.

Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers.

Background: Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).

Methods: We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network.

Necrotizing enterocolitis vs bowel ischemia of congenital heart disease: Apples and oranges.

Necrotizing enterocolitis (NEC) is a devastating illness with mortality rates approaching 26 ​%, with 4 ​% of patients with congenital heart disease (CHD) receiving this diagnosis. In this retrospective cohort study, the Pediatric Health Information System database was used to compare outcomes among patients with NEC diagnoses between 2019 and 2021 by CHD. The association of clinical factors with the outcomes of interest were compared using multivariable logistic regression.

Association of chronic kidney disease with acute clinical outcomes and hospitalization costs of cancer resection.

Purpose: Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been noted to face increased cancer incidence. Yet, the impact of concomitant renal dysfunction on acute outcomes following elective surgery for cancer remains to be elucidated.

Methods: All adult hospitalizations entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, or colon cancer were identified in the 2016-2020 National Inpatient Sample.

Age-stratified trends and outcomes of inpatient cholecystectomy for acute cholecystitis in the United States.

Background: The elderly population in the United States is rapidly expanding. Older patients over age 65 with acute cholecystitis may face greater perioperative risk compared to younger patients undergoing urgent laparoscopic cholecystectomy. We aimed to characterize trends in utilization and outcomes of inpatient cholecystectomy across the United States stratified by age.

Perspectives, Experiences, and Opportunities of Academic Surgeons in the Era of Healthcare Corporatization.

Objective: To characterize contemporary surgeons' viewpoints and perspectives on the academic mission during healthcare corporatization.

Summary Background Data: Academic surgery, traditionally driven by the tripartite missions of excellence in clinical care, scientific research, and education, faces increasing challenges from a corporatized healthcare environment. While previous studies have addressed the financial aspects of corporatization, a comprehensive evaluation of academic surgeons' attitudes and experiences remains lacking.

Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities.

Background And Objectives: Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded the availability of limb salvage; however, a subset of patients still require amputation. The aim of this study was to examine the impact of patient, disease, and practice-related factors on rates of amputation in STS.

Association of Community Socioeconomic Distress With Waitlist and Survival Outcomes in Liver Transplantation.

Background: Despite efforts to ensure equitable access to liver transplantation (LT), significant disparities remain. Although prior literature has considered the effects of patient sex, race, and income, the contemporary impact of community socioeconomic disadvantage on outcomes after waitlisting for LT remains to be elucidated. We sought to evaluate the association of community-level socioeconomic deprivation with survival after waitlisting for LT.

Care Fragmentation Following Bariatric Operations: A National Analysis.

Background: Although existing work has evaluated outcomes associated with care fragmentation (CF), these adverse consequences may be accentuated in patients undergoing bariatric operations. This retrospective study examined the association of CF with clinical and financial outcomes among patients receiving bariatric surgery.

Methods: All adult (≥18 years) records for bariatric operations were tabulated from the 2016-2021 Nationwide Readmissions Database.

Perioperative Extracorporeal Cardiopulmonary Resuscitation in Adults: A Single-center Retrospective Review and Analysis.

Background: Extracorporeal cardiopulmonary resuscitation (CPR) for refractory in-hospital cardiac arrest has been associated with improved survival compared with conventional CPR. Perioperative patients represent a unique cohort of the inpatient population. This study aims to describe and analyze the characteristics and outcomes of patients who received extracorporeal CPR for perioperative cardiac arrest.

A national perspective on palliative interventions for malignant gastric outlet obstruction.

Background: Of note, 15% to 20% of patients with duodenal or periampullary malignancies develop gastric outlet obstruction (GOO). Although small randomized trials have reported more rapid recovery and shorter hospital stay with endoscopic stenting (ES), limited studies have evaluated outcomes at a national level. The current study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) vs ES in malignant GOO.

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.

Travel to High-Volume Centers and Survival After Esophagectomy for Cancer.

Importance: Ongoing efforts have encouraged the regionalization of esophageal adenocarcinoma treatment to high-volume centers (HVCs). Yet such centralization has been linked with increased patient travel burden and reduced postoperative continuity of care.

Objective: To determine whether traveling to undergo esophagectomy at HVCs is linked with superior overall survival compared with receiving care locally at low-volume centers (LVC).