PM14 - A Multi-Institutional Analysis of Textbook Outcomes Among Patients Undergoing Cytoreductive Surgery for Peritoneal Surface Malignancies
Sunday, February 16, 2020
8:15 AM – 8:30 AM
Location: Sebastian I 1/2
Introduction: Composite measures may be superior to individual metrics for evaluating quality for complex surgical procedures. While recent studies have introduced the concept of a textbook outcome (TO) as a novel composite metric for measuring postoperative outcomes, the incidence and importance of a TO has not been previously characterized among patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies (PSM). Methods: All patients who underwent CRS ± hyperthermic intraperitoneal chemotherapy (HIPEC) between 1999-2017 from 12 academic institutions were included. Using expert consensus, TO was defined as: completeness of cytoreduction (CC) 0/1, no reoperation, no readmission within 90-days, no mortality within 90-days, no grade ≥2 complications, no prolonged hospital stay >75th percentile, and discharge to home. Univariate and multivariable analyses were used to determine factors associated with TO. Results: Among 1963 patients who underwent CRS, 43.1% were male, the median age was 55 years, the most common histology was appendiceal (65.0%), the mean peritoneal carcinomatosis index (PCI) was 14.6, and 86.0% underwent CC0/1 resection. Only 28.9% of patients achieved a TO, limited mostly due to postoperative complications (Figure). On multivariable analysis, factors associated with achieving a TO were albumin ≥3.5 g/dl (OR: 4.8), HIPEC (OR: 3.3), PCI ≤14 (OR: 2.3), intravenous fluid volume ≤5000 ml (OR: 2.4), and blood loss ≤1000ml (OR: 4.0), while splenectomy (OR: 0.7), liver resection (OR: 0.5), and receipt of neoadjuvant therapy (OR: 0.7) were not (all p<0.05). TO was associated with increased overall survival (median 156 months vs 55.7 months, p<0.01) even after controlling for confounders on Cox regression analysis (hazard ratio: 2.3, p<0.01). Conclusions: Among patients undergoing CRS ± HIPEC for PSM, failure to achieve a TO is common and associated with significantly worse overall survival. The use of composite metrics such as TO may enhance patient counseling by informing expectations and can serve as a valuable tool for measuring patient-level hospital performance.