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Identification of Risk Factors in Lymphatic Surgeries for Melanoma: A NSQIP review
Mona Ascha, Mustafa S Ascha, Brian Gastman
Cleveland Clinic Foundation
2017-01-26
Presenter: Mona Ascha
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. This represents original work by the authors.
Director Name: Mona Ascha
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Sentinel lymph node biopsy (SLNB) and lymphadenectomy (LAD) are performed in the treatment of malignant melanoma. Complications may result in hospital readmission, negatively affecting patient outcomes and procedure reimbursements. We utilized the NSQIP database to explore predictors of 30-day hospital readmission for SLNB and LAD in the axillary, cervical, and inguinal regions.
Methods: Data from 2005-2014 of ACS NSQIP was used. Cohorts were constructed using ICD-9 and CPT classification. The primary outcome was hospital readmission within 30 days. Multiple logistic regression was performed for a pre-specified set of predictors, and predictors that were significant on univariate logistic regression analysis. Odds ratios and confidence intervals were calculated.
Results: 3006 patients were included. Of those, 151 (5.0%) returned to the hospital. Among 1235 LAD patients, 65 (5.3%) returned; among 1771 SLNB patients, 86 (4.9%) returned. Smoking was a predictor of hospital readmission for overall SLNB and cervical SLNB on multivariate analysis. Age was a significant predictor for cervical LAD and inguinal LAD. Hypertension was significant for cervical LAD. Diabetes, pre-operative hematocrit, and male gender were predictors for inguinal SLNB. There were no significant predictors for axillary SLNB and axillary LAD, as well as overall LAD.
Conclusion: This is the first and largest study utilizing NSQIP to examine 30-day readmission following SLNB and LAD for melanoma in three anatomical regions. We found several risk factors associated with readmission, which is being used as a quality measure for hospital performance and reimbursement. This may help surgeons optimize patient selection for SLNB and LAD.
