Evidence map›Paper›PMID 33598723›Full record

ArticleWorld journal of surgery2021

Strong for Surgery: Association Between Bundled Risk Factors and Outcomes After Major Elective Surgery in the VA Population.

Douglas Z Liou, Deven C Patel, Prasha Bhandari, Sherry M Wren, Nell J Marshall, Alex Hs Harris, Joseph B Shrager, Mark F Berry, Natalie S Lui, Leah M Backhus

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Article in World journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Douglas Z LiouDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Deven C PatelDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Prasha BhandariDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Sherry M WrenDepartment of Surgery, Stanford University, Stanford, CA, USA.
Nell J MarshallVA Palo Alto Health Care System, Palo Alto, CA, USA.
Alex Hs HarrisDepartment of Surgery, Stanford University, Stanford, CA, USA.
Joseph B ShragerDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Mark F BerryDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Natalie S LuiDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.
Leah M BackhusDivision of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA. lbackhus@stanford.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundStrong for Surgery (S4S) is a public health campaign focused on optimizing patient health prior to surgery by identifying evidence-based modifiable risk factors. The potential impact of S4S bundled risk factors on outcomes after major surgery has not been previously studied. This study tested the hypothesis that a higher number of S4S risk factors is associated with an escalating risk of complications and mortality after major elective surgery in the VA population.

methodsThe Veterans Affairs Surgical Quality Improvement Program (VASQIP) database was queried for patients who underwent major non-emergent general, thoracic, vascular, urologic, and orthopedic surgeries between the years 2008 and 2015. Patients with complete data pertaining to S4S risk factors, specifically preoperative smoking status, HbA1c level, and serum albumin level, were stratified by number of positive risk factors, and perioperative outcomes were compared.

resultsA total of 31,285 patients comprised the study group, with 16,630 (53.2%) patients having no S4S risk factors (S4S0), 12,323 (39.4%) having one (S4S1), 2,186 (7.0%) having two (S4S2), and 146 (0.5%) having three (S4S3). In the S4S1 group, 60.3% were actively smoking, 35.2% had HbA1c > 7, and 4.4% had serum albumin < 3. In the S4S2 group, 87.8% were smokers, 84.8% had HbA1c > 7, and 27.4% had albumin < 3. Major complications, reoperations, length of stay, and 30-day mortality increased progressively from S4S0 to S4S3 groups. S4S3 had the greatest adjusted mortality risk (adjusted odds radio [AOR] 2.56, p = 0.04) followed by S4S2 (AOR 1.58, p = 0.02) and S4S1 (AOR 1.34, p = 0.02).

conclusionIn the VA population, patients who had all three S4S risk factors, namely active smoking, suboptimal nutritional status, and poor glycemic control, had the greatest risk of postoperative mortality compared to patients with fewer S4S risk factors.

Indexed as

Elective Surgical ProceduresHospitals, VeteransHumansPostoperative ComplicationsQuality ImprovementRetrospective StudiesRisk FactorsUnited States

Identifiers

PMID33598723

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.