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

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 cytoreductiv...

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Bibliographic Details
Published in:Journal of surgical oncology 2020-10, Vol.122 (5), p.980-985
Main Authors: Eng, Oliver S., Blakely, Andrew M., Lafaro, Kelly J., Fournier, Keith F., Fackche, Nadege T., Johnston, Fabian M., Dineen, Sean, Powers, Benjamin, Hendrix, Ryan, Lambert, Laura A., Ronnekleiv‐Kelly, Sean, Walle, Kara Vande, Grotz, Travis E., Leiting, Jennifer L., Patel, Sameer H., Dhar, Vikrom K., Baumgartner, Joel M., Lowy, Andrew M., Clarke, Callisia N., Mogal, Harveshp, Zaidi, Mohammad Y., Staley, Charles A., Kimbrough, Charles, Cloyd, Jordan M., Lee, Byrne, Raoof, Mustafa
Format: Article
Language:English
Subjects:
Chemotherapy
Cohort Studies
Cytoreduction Surgical Procedures - methods
Cytoreduction Surgical Procedures - standards
Cytoreduction Surgical Procedures - statistics & numerical data
cytoreductive surgery
Enhanced Recovery After Surgery
ERAS
Female
HIPEC
Humans
Hyperthermic Intraperitoneal Chemotherapy - methods
Hyperthermic Intraperitoneal Chemotherapy - statistics & numerical data
Male
Middle Aged
Neoplasms - drug therapy
Neoplasms - surgery
Neoplasms - therapy
Perioperative care
Recovery (Medical)
Retrospective Studies
Surgery
Treatment Outcome
variation
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Summary: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 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.26099