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Research Letter
November 2016

Role of Operative Complexity Variables in Risk Adjustment for Patients With Cancer

Author Affiliations
  • 1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
  • 2Department of Surgery, University of Chicago Hospitals, Chicago, Illinois
  • 3Department of Surgery, University of Wisconsin Carbone Cancer Center, Madison
  • 4Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
  • 5Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
  • 6Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(11):1084-1086. doi:10.1001/jamasurg.2016.2253

The comprehensive capture of relevant details of patients is essential to accurately predict outcomes and benchmark hospital performance.1 Members of the Oncology NSQIP National Cancer Center Collaborative (ONNCC), established in 2011, were concerned that important oncology-related variables were not captured by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The ONNCC began collecting 3 additional case characteristics representing greater operative complexity and risk with the aim to improve patient risk prediction and case-mix adjustment.2

Trained surgical clinical reviewers from 16 ONNCC hospitals abstracted 3 novel variables not routinely collected in ACS NSQIP (“Previous Surgery in the Operative Region,” “Previous Radiotherapy to the Operative Region,” and “Previous Chemotherapy”). All variables were stratified by time from surgery (≥90 days vs <90 days). For example, consider a patient with a distant history of prostatectomy and adjuvant pelvic radiotherapy now undergoing low anterior resection for rectal cancer. The operative region (the pelvis) will be reentered; thus, the data coded for this patient is “Previous Surgery: ≥90 days,” “Previous Radiotherapy: ≥90 days,” and “Previous Chemotherapy: None.”