Effect of conditions being present at time of surgery (PATOS) on outcomes in liver surgery

• Published in: The American journal of surgery 2024-02, Vol.228, p.213-217
• Main Authors: Jehan, Faisal S., Ganguli, Sangrag, Saif, Areeba, Hase, Niklas E., Nayak, Paramita S., Nayyar, Apoorve, Aziz, Hassan
• Format: Article
• Language: English
• Subjects: Accounting; Complications; Health maintenance organizations; Hepatectomy; HMOs; Humans; Inertia; Infectious diseases; Liver; Mortality; Patients; Pneumonia; Postoperative; Postoperative Complications - epidemiology; Postoperative period; Quality control; Quality Improvement; Retrospective Studies; Risk Factors; Sepsis; Sepsis - epidemiology; Septic shock; Surgery; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Urinary tract; Urinary Tract Infections; Variables; Ventilators
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2023.09.046

Information about condition(s) being present at time of surgery (PATOS) in the American College of Surgeons (ASC) National Surgical Quality Improvement Program (NSQIP) database can influence the postoperative complication rates after liver surgeries. Here, we compare the postoperative complication rates with and without taking condition(s) being PATOS into account. We retrospectively reviewed the ACS NSQIP Participant User Files (PUFs) from 2015 through 2019. We analyzed rates of eight different postoperative complications: superficial surgical site infection (SSI), deep SSI, organ space SSI, pneumonia, urinary tract infection, ventilator, sepsis, and septic shock. In addition, we calculated the percent change in event rates after taking into account whether a condition is PATOS. Of the 22,463 patients in the ACS NSQIP PUFs for liver surgery, 334 (1.49%) had one or more conditions PATOS. The percentages of patients with PATOS events ranged from 2.03% for superficial SSI to 14.74% for sepsis. For all complications, event rates declined when taking condition(s) PATOS into account. From 2015 through 2019, the observed-to-expected ratios for most complications remained unchanged. Whether a condition is PATOS is important in reporting postoperative complication rates for patients undergoing liver surgery. When taking whether a condition is PATOS into account, we demonstrated an overall decrease in event rates across all eight postoperative complications. [Display omitted] •For all complications, event rates declined when taking PATOS into account.•During the study period, the observed-to-expected ratios for most complications remained unchanged.•When calculating postoperative infections and other complications, failure to exclude conditions PATOS makes doctors, facilities, and institutions that care for sicker patients look much worse than those who cherry-pick less-ill patients.•Excluding PATOS factors produces more accurate evaluations of complications, which is important for patients, doctors, hospitals and surgical research.