Surgical outcomes of hyperthermic intraperitoneal chemotherapy: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

Mehraneh D. Jafari, Wissam J Halabi, Michael J. Stamos, Vinh Q. Nguyen, Joseph C. Carmichael, Steven D. Mills, Alessio Pigazzi

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC. OBJECTIVE: To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011. MAIN OUTCOMES AND MEASURES: Thirty-day mortality and morbidity. RESULTS: Of the cancers identified among the 694 sampled cases, 14%of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8%had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70%of patients. The average operative time was 7.6 hours, with 15%of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%. CONCLUSIONS AND RELEVANCE: American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)170-175
Number of pages6
JournalJAMA Surgery
Volume149
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Quality Improvement
Drug Therapy
Mortality
Morbidity
Neoplasms
Appendiceal Neoplasms
Intraoperative Complications
Operative Time
Septic Shock
Reoperation
Colorectal Neoplasms
Length of Stay
Demography
Outcome Assessment (Health Care)
Hemorrhage
Carcinoma
Lung
Infection

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical outcomes of hyperthermic intraperitoneal chemotherapy : Analysis of the American College of Surgeons National Surgical Quality Improvement Program. / Jafari, Mehraneh D.; Halabi, Wissam J; Stamos, Michael J.; Nguyen, Vinh Q.; Carmichael, Joseph C.; Mills, Steven D.; Pigazzi, Alessio.

In: JAMA Surgery, Vol. 149, No. 2, 01.02.2014, p. 170-175.

Research output: Contribution to journalArticle

Jafari, Mehraneh D. ; Halabi, Wissam J ; Stamos, Michael J. ; Nguyen, Vinh Q. ; Carmichael, Joseph C. ; Mills, Steven D. ; Pigazzi, Alessio. / Surgical outcomes of hyperthermic intraperitoneal chemotherapy : Analysis of the American College of Surgeons National Surgical Quality Improvement Program. In: JAMA Surgery. 2014 ; Vol. 149, No. 2. pp. 170-175.
@article{9e0ff1bf432a4417843c7d024bf6d09f,
title = "Surgical outcomes of hyperthermic intraperitoneal chemotherapy: Analysis of the American College of Surgeons National Surgical Quality Improvement Program",
abstract = "IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC. OBJECTIVE: To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011. MAIN OUTCOMES AND MEASURES: Thirty-day mortality and morbidity. RESULTS: Of the cancers identified among the 694 sampled cases, 14{\%}of patients had appendiceal cancer, 11{\%} had primary peritoneal cancer, and 8{\%}had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70{\%}of patients. The average operative time was 7.6 hours, with 15{\%}of patients requiring intraoperative transfusions. Postoperative bleeding (17{\%}), septic shock (16{\%}), pulmonary complications (15{\%}), and organ-space infections (9{\%}) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11{\%}. The rate of reoperation was 10{\%}, with an overall mortality rate of 2{\%}. CONCLUSIONS AND RELEVANCE: American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.",
author = "Jafari, {Mehraneh D.} and Halabi, {Wissam J} and Stamos, {Michael J.} and Nguyen, {Vinh Q.} and Carmichael, {Joseph C.} and Mills, {Steven D.} and Alessio Pigazzi",
year = "2014",
month = "2",
day = "1",
doi = "10.1001/jamasurg.2013.3640",
language = "English (US)",
volume = "149",
pages = "170--175",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Surgical outcomes of hyperthermic intraperitoneal chemotherapy

T2 - Analysis of the American College of Surgeons National Surgical Quality Improvement Program

AU - Jafari, Mehraneh D.

AU - Halabi, Wissam J

AU - Stamos, Michael J.

AU - Nguyen, Vinh Q.

AU - Carmichael, Joseph C.

AU - Mills, Steven D.

AU - Pigazzi, Alessio

PY - 2014/2/1

Y1 - 2014/2/1

N2 - IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC. OBJECTIVE: To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011. MAIN OUTCOMES AND MEASURES: Thirty-day mortality and morbidity. RESULTS: Of the cancers identified among the 694 sampled cases, 14%of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8%had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70%of patients. The average operative time was 7.6 hours, with 15%of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%. CONCLUSIONS AND RELEVANCE: American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.

AB - IMPORTANCE: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC. OBJECTIVE: To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011. MAIN OUTCOMES AND MEASURES: Thirty-day mortality and morbidity. RESULTS: Of the cancers identified among the 694 sampled cases, 14%of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8%had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70%of patients. The average operative time was 7.6 hours, with 15%of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%. CONCLUSIONS AND RELEVANCE: American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.

UR - http://www.scopus.com/inward/record.url?scp=84894544530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894544530&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2013.3640

DO - 10.1001/jamasurg.2013.3640

M3 - Article

C2 - 24352601

AN - SCOPUS:84894544530

VL - 149

SP - 170

EP - 175

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 2

ER -