Frailty Predicts Loss of Independence After Liver Surgery

Background: The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS-NSQIP database, this study examined the methodological reporting of HPB publications. Study Design: Web of Science core collection (all editions) was queried for all HPB studies using the ACS-NSQIP database published between 2004 and 2022. In addition, a critical appraisal was performed using the JAMA (Journal of American Medical Association)-Surgery Checklist, STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Statement, and RECORD (Reporting of studies Conducted using Observational Routinely-collected Health Data) Statement. Results: In total, 276 studies were included in the analysis. The median scores for the JAMA-Surgery Checklist, RECORD Statement, and STROBE Statement were 4 of 7 (IQR 3, 5), 3 of 10 (IQR 2, 4), and 15 of 21 (IQR 13, 17), respectively. The criteria with the highest rates of nonadherence were discussing competing risks, clear definitions of inclusion and exclusion criteria, unadjusted and adjusted outcomes, provision of supplementary data, and performing subgroup analyses. Additionally, when examining checklist fulfillment of hepatobiliary studies and pancreatic studies separately, pancreatic studies demonstrated significantly greater fulfillment of the STROBE Statement checklist items. Conclusion: Satisfactory reporting of methodology is present among HPB studies utilizing the ACS-NSQIP database, with multiple opportunities for improvement. Areas for improved adherence include discussing competing risks, providing supplementary information, and performing appropriate subgroup analysis. Given the increasing role of large-scale databases in surgical research, enhanced commitment to reporting guidelines may advance HPB research and ensure quality reporting. 

Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database

Background Chronic steroid use has been associated with increased postoperative complication; however, the association between chronic steroids and hepatobiliary and pancreatic surgery through all aspects of disease etiologies and types of surgery performed remains an area of active research. Therefore, this study analyzed the association of chronic steroids use with outcomes after hepatobiliary and pancreatic surgery. Methods The National Surgical Quality Improvement Program Participant Use Data Files for hepatobiliary and pancreatic surgeries performed between 2015 and 2019 were analyzed for chronic steroid use and postoperative adverse events. Results A total of 54,382 patients underwent hepatobiliary or pancreatic surgery during the study period, of which 1672 (3.1%) were on chronic steroids. In patients undergoing pancreatic surgery, steroid use was associated with higher rates of pneumonia (odds ratio [OR] 1.3, 95% confidence interval [95% CI] 1.2–2.2), unplanned intubation (OR 1.2, 95% CI 1.1–2.3), readmission (OR 1.4, 95% CI 1.3–2.4), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.2–2.3), being more likely to remain on a ventilator for greater than 48 h (OR 1.4, 95% CI 1.2–1.9), and greater mortality (OR 1.2, 95% CI 1.1–3.1) when compared to those, not on chronic steroids. In patients undergoing hepatobiliary surgery, chronic steroid use was associated with higher rates of sepsis (OR 1.3, 95% CI 1.2–2.9), unplanned intubation (OR 1.4, 95% CI 1.2–2.7), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.3–2.3), and readmission (OR 1.2, 95% CI 1.0–1.9). There was no difference in pancreatic fistula rates or post-hepatectomy liver failure rates after pancreatic and hepatobiliary resections, respectively. Conclusion Chronic steroids use was associated with higher rates of poor outcomes both perioperatively and postoperatively in pancreatic and hepatobiliary surgery. These results will allow clinicians to be better equipped to counsel patients on surgery's increased risks and establish various perioperative protocols for chronic steroid users. 

Association between chronic steroids and outcomes in hepatobiliary and pancreatic surgery.

Perceptions of General Surgery Program Leadership and Residents on Research Sabbatical.

Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database

Should Radiological Assessment be Part of Core General Surgery Competency? A Survey of the General Surgery Residents

Evaluating General Surgical Residency Education Structure and Incorporation of the Resident as Educator Model.

Background. Recently, a new liver allocation policy called the acuity circles (AC) framework was implemented to decrease geographic disparities in transplant metrics across donor service areas. Early analyses have examined the changes in outcomes because of the AC policy. However, perceptions among transplant surgeons and staff regarding the new policy remain unknown. Methods. A 28-item survey was sent to division chiefs and surgical directors of liver transplantation across the United States. Questions assessed the respondents’ perceptions regarding center-level metrics and staff satisfaction. We used Organ Procurement and Transplantation Network data to study differences in allocation between the pre-AC implementation period (2019) and the post-AC implementation period (2020–2021). Results. A total of 40 participants completed this ongoing survey study. Most responses were from region 8 (13%), region 10 (15%), and region 11 (13%). Sixty-three percent of respondents stated that the wait time for a suitable offer for recipients with model of end-stage liver disease score <30 has decreased, whereas 50% stated that wait time for a suitable offer for recipients with model of end-stage liver disease score >30 has increased. However, most respondents (75%) felt that the average cost per transplant had increased and that the rate of surgical complications and 1-y graft survival had remained the same. In most states, an observable decrease in in-state liver transplantations occurred each year between 2019 and 2021. In addition, most allocation regions reported an increase in donations after circulatory deaths between 2019 and 2021. Conclusions. Perceptions of the new AC policy among liver transplant surgeons in the United States remain mixed, highlighting the potential strengths and concerns regarding its future impact. Further studies should assess the effects of the AC policy on clinical outcomes and liver transplantation access.

Saba Alvi

Papers

Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database

Should Radiological Assessment be Part of Core General Surgery Competency? A Survey of the General Surgery Residents

Evaluating General Surgical Residency Education Structure and Incorporation of the Resident as Educator Model.

Perceptions and Early Outcomes of the Acuity Circles Allocation Policy Among Liver Transplant Centers in the United States

Perceptions of General Surgery Program Leadership and Residents on Research Sabbatical.