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Institutional variation in recovery after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: An opportunity for enhanced recovery pathways
Author(s) -
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.,
RonnekleivKelly 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
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26099
Subject(s) - medicine , perioperative , hyperthermic intraperitoneal chemotherapy , retrospective cohort study , cohort , logistic regression , academic institution , emergency medicine , general surgery , surgery , intensive care medicine , cytoreductive surgery , cancer , management , economics , ovarian cancer
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.