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CDA 08-018 – HSR&D Study

 
CDA 08-018
Quality Measures in Cancer Surgery
David J Bentrem MD MS
Jesse Brown VA Medical Center, Chicago, IL
Chicago, IL
Funding Period: August 2009 - July 2014

BACKGROUND/RATIONALE:
For high-risk cancer procedures, it is well established that patients undergoing surgery at low-volume hospitals have higher risk of complications and perioperative mortality than those at high-volume centers. This will not only affect perioperative outcome but may also affect utilization of surgical and non-surgical treatment. Variations in short- and long-term outcome among hospitals and patient groups also suggest the safety and application of cancer treatment can be improved. U.S. veterans have been shown to be a vulnerable population with high cancer rates, yet practice pattern information is lacking. Furthermore, defining and improving the "quality" of cancer care has been a tremendous challenge. New measures of surgical quality needed to be assessed. The National Cancer Data Base provides the most comprehensive and balanced comparison opportunity for VA surgical care. We hypothesize that stage specific treatments for gastrointestinal cancer are underutilized and vary among VA hospitals as well as other hospitals in the United States. We further hypothesize that measures of cancer surgery quality can be assessed on the hospital level and used to guide improvements in the care of cancer patients.

OBJECTIVE(S):
Aim 1. To assess treatment utilization for gastrointestinal malignancy (pancreas, esophagus, gastric, colon and rectal cancer) and the influence of patient factors (age, comorbidities, race, socioeconomic status) and hospital factors (center type, procedure volume) on receiving cancer care at the VA

Aim 2. To evaluate indicators of surgical quality for localized gastrointestinal malignancy and the influence of patient factors and hospital factors on hospital compliance

METHODS:
This proposal will address the unevenness of cancer care in the United States. We will conduct a retrospective cohort study to investigate treatment utilization and indicators of surgical quality for 5 sites of GI malignancy. Given the complexity of the health care system, many factors are likely to influence whether patients receive "recommended" therapies. Given these varied practice patterns, we seek to identify how patients with gastrointestinal malignancy are treated and how treatment utilization is related to patient factors (age, race and socioeconomic status) and hospital factors (type and volume). Furthermore we seek to compare cancer care and surgical quality indicators at the VA to other center types. Other initiatives have compared care at the VA to high volume centers; however, it remains important to compare VA hospitals with other center types such as community and non-academic centers. This proposal will define the extent to which veterans are receiving state of the art cancer care for GI malignancy. This proposal will also allow for development of quality measures enabling internal and external comparisons and targeted program development. These quality measures can then be further used to monitor and document improvement in clinical cancer care.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
With my primary mentor Dr. Clifford Ko, we have evaluated time to treatment at VA for eight different cancers and compared this to non-VA centers using the National Cancer Database. The time to treatment has increased dramatically for all eight cancers evaluated and was dependent upon patient and hospital factors. This kind of comparison is quite unique and will be very informative as we develop benchmarks for cancer care delivery.

Venous thromboembolism remains the #1 cause of death for veterans after cancer surgery. Using the National Surgical Quality Improvement Program data, we evaluated the risks associated with specific cancer types and procedures to identify those highest risk after cancer surgery. We seek to implement a clinical trial or point of care testing project for highest risk patients to lower the occurrence of this devestating complication.

Our surgical service re-examined colon cancer outcomes of the Office of Quality and Performance for our hospital and found variation with a higher level review. I have worked with the Jesse Brown leadership to secure resources to implement pathways and personnel to improve preoperative staging and decrease time to treatment for veterans at Jesse Brown with colon cancer. In addition, we have started the first Jesse Brown Multidisciplanary Tumor Conferece to improve care coordination between disciplines. We will continue efforts to start a virtual tumor board throughout VISN 12 to promote efficient cancer care for veterans



External Links for this Project

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PUBLICATIONS:

Journal Articles

  1. Merkow RP, Bilimoria KY, Sohn MW, Oh EH, Sellers MM, Paruch JL, Chung JW, Bentrem DJ. Adherence with postdischarge venous thromboembolism chemoprophylaxis recommendations after colorectal cancer surgery among elderly Medicare beneficiaries. Annals of surgery. 2014 Jul 1; 260(1):103-8. [view]
  2. Hayman AV, Chang ET, Molokie RE, Kahng LS, Prystowsky JB, Bentrem DJ. Assessing compliance with national quality measures to improve colorectal cancer care at the VA. American journal of surgery. 2010 Nov 1; 200(5):572-6. [view]
  3. Sherman KL, Merkow RP, Shah AM, Wang CE, Bilimoria KY, Bentrem DJ. Assessment of advanced gastric cancer management in the United States. Annals of Surgical Oncology. 2013 Jul 1; 20(7):2124-31. [view]
  4. Bilimoria KY, Cohen ME, Merkow RP, Wang X, Bentrem DJ, Ingraham AM, Richards K, Hall BL, Ko CY. Comparison of outlier identification methods in hospital surgical quality improvement programs. Journal of Gastrointestinal Surgery : Official Journal of The Society For Surgery of The Alimentary Tract. 2010 Oct 1; 14(10):1600-7. [view]
  5. Abbott DE, Merkow RP, Cantor SB, Fleming JB, Varadhachary GR, Crane C, Bentrem DJ, Bilimoria KY. Cost-effectiveness of treatment strategies for pancreatic head adenocarcinoma and potential opportunities for improvement. Annals of Surgical Oncology. 2012 Nov 1; 19(12):3659-67. [view]
  6. Strouch MJ, Cheon EC, Salabat MR, Krantz SB, Gounaris E, Melstrom LG, Dangi-Garimella S, Wang E, Munshi HG, Khazaie K, Bentrem DJ. Crosstalk between mast cells and pancreatic cancer cells contributes to pancreatic tumor progression. Clinical Cancer Research : An Official Journal of The American Association For Cancer Research. 2010 Apr 15; 16(8):2257-65. [view]
  7. Merkow RP, Bentrem DJ, Chung JW, Paruch JL, Ko CY, Bilimoria KY. Differences in patients, surgical complexity, and outcomes after cancer surgery at National Cancer Institute-designated cancer centers compared to other hospitals. Medical care. 2013 Jul 1; 51(7):606-13. [view]
  8. Merkow RP, Bentrem DJ, Cohen ME, Paruch JL, Weber SM, Ko CY, Bilimoria KY. Effect of cancer surgery complexity on short-term outcomes, risk predictions, and hospital comparisons. Journal of the American College of Surgeons. 2013 Oct 1; 217(4):685-93. [view]
  9. Merkow RP, Bilimoria KY, McCarter MD, Chow WB, Gordon HS, Stewart AK, Ko CY, Bentrem DJ. Effect of histologic subtype on treatment and outcomes for esophageal cancer in the United States. Cancer. 2012 Jul 1; 118(13):3268-76. [view]
  10. Merkow RP, Kmiecik TE, Bentrem DJ, Winchester DP, Stewart AK, Ko CY, Bilimoria KY. Effect of including cancer-specific variables on models examining short-term outcomes. Cancer. 2013 Apr 1; 119(7):1412-9. [view]
  11. Bilimoria KY, Cohen ME, Ingraham AM, Bentrem DJ, Richards K, Hall BL, Ko CY. Effect of postdischarge morbidity and mortality on comparisons of hospital surgical quality. Annals of surgery. 2010 Jul 1; 252(1):183-90. [view]
  12. Merkow RP, Bentrem DJ, Mulcahy MF, Chung JW, Abbott DE, Kmiecik TE, Stewart AK, Winchester DP, Ko CY, Bilimoria KY. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Annals of surgery. 2013 Dec 1; 258(6):847-53. [view]
  13. Merkow RP, Bilimoria KY, Sherman KL, McCarter MD, Gordon HS, Bentrem DJ. Efficiency of colorectal cancer care among veterans: analysis of treatment wait times at Veterans Affairs Medical Centers. Journal of oncology practice / American Society of Clinical Oncology. 2013 Jul 1; 9(4):e154-63. [view]
  14. Bilimoria KY, Chung J, Ju MH, Haut ER, Bentrem DJ, Ko CY, Baker DW. Evaluation of surveillance bias and the validity of the venous thromboembolism quality measure. JAMA. 2013 Oct 9; 310(14):1482-9. [view]
  15. Phillips JD, Merkow RP, Sherman KL, DeCamp MM, Bentrem DJ, Bilimoria KY. Factors affecting selection of operative approach and subsequent short-term outcomes after anatomic resection for lung cancer. Journal of the American College of Surgeons. 2012 Aug 1; 215(2):206-15. [view]
  16. Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY. Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Archives of surgery (Chicago, Ill. : 1960). 2009 Nov 1; 144(11):1013-20. [view]
  17. Blatner NR, Bonertz A, Beckhove P, Cheon EC, Krantz SB, Strouch M, Weitz J, Koch M, Halverson AL, Bentrem DJ, Khazaie K. In colorectal cancer mast cells contribute to systemic regulatory T-cell dysfunction. Proceedings of the National Academy of Sciences of the United States of America. 2010 Apr 6; 107(14):6430-5. [view]
  18. Bilimoria KY, Wayne JD, Merkow RP, Abbott DE, Cormier JN, Feig BW, Hunt KK, Pisters PW, Pollock R, Bentrem DJ. Incorporation of adjuvant therapy into the multimodality management of gastrointestinal stromal tumors of the stomach in the United States. Annals of Surgical Oncology. 2012 Jan 1; 19(1):184-91. [view]
  19. Shields MA, Krantz SB, Bentrem DJ, Dangi-Garimella S, Munshi HG. Interplay between ß1-integrin and Rho signaling regulates differential scattering and motility of pancreatic cancer cells by snail and Slug proteins. The Journal of Biological Chemistry. 2012 Feb 24; 287(9):6218-29. [view]
  20. Wasif N, Bentrem DJ, Farrell JJ, Ko CY, Hines OJ, Reber HA, Tomlinson JS. Invasive intraductal papillary mucinous neoplasm versus sporadic pancreatic adenocarcinoma: a stage-matched comparison of outcomes. Cancer. 2010 Jul 15; 116(14):3369-77. [view]
  21. Chalian H, Töre HG, Rezai P, Bentrem DJ, Yaghmai V. MDCT evaluation of the growth kinetics of serous and benign mucinous cystic neoplasms of the pancreas. Cancer imaging : the official publication of the International Cancer Imaging Society. 2011 Aug 20; 11:116-22. [view]
  22. Merkow RP, Bilimoria KY, Bentrem DJ, Pitt HA, Winchester DP, Posner MC, Ko CY, Pawlik TM. National assessment of margin status as a quality indicator after pancreatic cancer surgery. Annals of Surgical Oncology. 2014 Apr 1; 21(4):1067-74. [view]
  23. Raval MV, Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY, Reynolds M. Nodal evaluation in Wilms' tumors: analysis of the national cancer data base. Annals of surgery. 2010 Mar 1; 251(3):559-65. [view]
  24. Shields MA, Dangi-Garimella S, Krantz SB, Bentrem DJ, Munshi HG. Pancreatic cancer cells respond to type I collagen by inducing snail expression to promote membrane type 1 matrix metalloproteinase-dependent collagen invasion. The Journal of Biological Chemistry. 2011 Mar 25; 286(12):10495-504. [view]
  25. Liu JY, Ellis RJ, Hu QL, Cohen ME, Hoyt DB, Yang AD, Bentrem DJ, Ko CY, Pawlik TM, Bilimoria KY, Merkow RP. Post Hepatectomy Liver Failure Risk Calculator for Preoperative and Early Postoperative Period Following Major Hepatectomy. Annals of Surgical Oncology. 2020 Aug 1; 27(8):2868-2876. [view]
  26. Merkow RP, Bilimoria KY, McCarter MD, Cohen ME, Barnett CC, Raval MV, Caprini JA, Gordon HS, Ko CY, Bentrem DJ. Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis. Annals of surgery. 2011 Jul 1; 254(1):131-7. [view]
  27. Merkow RP, Bilimoria KY, Tomlinson JS, Paruch JL, Fleming JB, Talamonti MS, Ko CY, Bentrem DJ. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Annals of surgery. 2014 Aug 1; 260(2):372-7. [view]
  28. Tarlov E, Lee TA, Weichle TW, Durazo-Arvizu R, Zhang Q, Perrin R, Bentrem D, Hynes DM. Reduced overall and event-free survival among colon cancer patients using dual system care. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2012 Dec 1; 21(12):2231-41. [view]
  29. Bilimoria KY, Bentrem DJ, Talamonti MS, Stewart AK, Winchester DP, Ko CY. Risk-based selective referral for cancer surgery: a potential strategy to improve perioperative outcomes. Annals of surgery. 2010 Apr 1; 251(4):708-16. [view]
  30. Merkow RP, Bilimoria KY, McCarter MD, Phillips JD, DeCamp MM, Sherman KL, Ko CY, Bentrem DJ. Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation. Archives of surgery (Chicago, Ill. : 1960). 2012 Nov 1; 147(11):1009-16. [view]
  31. Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Annals of surgery. 2009 Jan 1; 249(1):63-71. [view]
  32. Sherman KL, Gordon EJ, Mahvi DM, Chung J, Bentrem DJ, Holl JL, Bilimoria KY. Surgeons' perceptions of public reporting of hospital and individual surgeon quality. Medical care. 2013 Dec 1; 51(12):1069-75. [view]
  33. Raval MV, Wang X, Cohen ME, Ingraham AM, Bentrem DJ, Dimick JB, Flynn T, Hall BL, Ko CY. The influence of resident involvement on surgical outcomes. Journal of the American College of Surgeons. 2011 May 1; 212(5):889-98. [view]
  34. Raval MV, Bentrem DJ, Eskandari MK, Ingraham AM, Hall BL, Randolph B, Ko CY, Morton JM. The role of Surgical Champions in the American College of Surgeons National Surgical Quality Improvement Program--a national survey. The Journal of surgical research. 2011 Mar 1; 166(1):e15-25. [view]
  35. Dangi-Garimella S, Krantz SB, Barron MR, Shields MA, Heiferman MJ, Grippo PJ, Bentrem DJ, Munshi HG. Three-dimensional collagen I promotes gemcitabine resistance in pancreatic cancer through MT1-MMP-mediated expression of HMGA2. Cancer Research. 2011 Feb 1; 71(3):1019-28. [view]
  36. Sherman KL, Merkow RP, Bilimoria KY, Wang CE, Mulcahy MF, Benson AB, Bentrem DJ. Treatment trends and predictors of adjuvant and neoadjuvant therapy for gastric adenocarcinoma in the United States. Annals of Surgical Oncology. 2013 Feb 1; 20(2):362-70. [view]
  37. Merkow RP, Bilimoria KY, Keswani RN, Chung J, Sherman KL, Knab LM, Posner MC, Bentrem DJ. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. Journal of the National Cancer Institute. 2014 Jul 1; 106(7):10.1093/jnci/dju133. [view]
  38. Merkow RP, Bilimoria KY, McCarter MD, Chow WB, Ko CY, Bentrem DJ. Use of multimodality neoadjuvant therapy for esophageal cancer in the United States: assessment of 987 hospitals. Annals of Surgical Oncology. 2012 Feb 1; 19(2):357-64. [view]
  39. Sellers MM, Merkow RP, Halverson A, Hinami K, Kelz RR, Bentrem DJ, Bilimoria KY. Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. Journal of the American College of Surgeons. 2013 Mar 1; 216(3):420-7. [view]
  40. Merkow RP, Bilimoria KY, Chow WB, Merkow JS, Weyant MJ, Ko CY, Bentrem DJ. Variation in lymph node examination after esophagectomy for cancer in the United States. Archives of surgery (Chicago, Ill. : 1960). 2012 Jun 1; 147(6):505-11. [view]
  41. Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, Winchester DP, Bentrem DJ. Wait times for cancer surgery in the United States: trends and predictors of delays. Annals of surgery. 2011 Apr 1; 253(4):779-85. [view]
Conference Presentations

  1. Heiferman MJ, Heiferman J, Blatner N, Cheon E, Phillips J, Knab M, Grippo P, Bentrem D. 5-Lipoxygenase Inhibition Attenuates Intestinal Polyposis through Suppression of Inflammation. Paper presented at: Academic Surgical Congress; 2013 Feb 5; New Orleans, LA. [view]
  2. Sherman KL, Wayne JD, Bentrem D, Bilimoria KY. Assessment of multimodality therapy use for extremity sarcoma in the United States. Poster session presented at: American Society of Clinical Oncology Annual Meeting; 2013 Jun 3; Chicago, IL. [view]
  3. Merkow R, Bentrem D, Cohen M, Ko C, Bilimoria K. Can Surgical Case Complexity Be Captured Better? Effect of Secondary CPT Codes on Short-Term Outcome Models after Gastrointestinal Oncologic Operations. Paper presented at: Academic Surgical Congress; 2013 Feb 5; New Orleans, LA. [view]
  4. Paruch J, Merkow RP, Bilimoria KY, Cohen M, Bentrem D, Posher M, Ko CY, Weber SM. Can the complexity of hepatectomy be captured better? Impact of secondary CPT codes on outcomes and hospital quality rankings. Paper presented at: American College of Surgeons Annual Clinical Congress; 2013 Oct 7; Washington, DC. [view]
  5. Merkow R, Bentrem D, Ko C, Bilimoria K. Can We Measure the Quality of Complex Cancer Surgery? Comparison of Patients and Outcomes at National Cancer Institute Designated Cancer Centers (NCI-CC) vs. Non-NCI Centers. Paper presented at: American College of Surgeons National Surgical Quality Improvement Program Annual Meeting; 2012 Oct 5; Chicago, IL. [view]
  6. Guihan M, Hayman A, Fischer M, Anaya B, Parachuri M, Bentrem D. Colonoscopy in Veterans with Spinal Cord Injury. Poster session presented at: American Spinal Injury Association Annual Meeting; 2011 Jun 8; Washington, DC. [view]
  7. Weichle TW, Zhang Q, Durazo-Arvizu R, Bentrem D, Hynes DM. Comparing Colon Cancer Outcomes Across Systems of Care: Patients with Stage IV Cancer in VA and SEER-Medicare Data. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA. [view]
  8. Merkow RP, Kmiecik T, Adams E, Bentrem D, Cohen M, Hall B, Ho C, Bilimoria KY. Do cancer specific variables affect risk-adjusted hospital quality comparisons? Paper presented at: Society of Surgical Oncology Cancer Annual Symposium; 2012 Mar 22; Orlando, FL. [view]
  9. Merkow RP, Bilimoria KY, Gordon HS, Stewart A, Ko C, Bentrem D. Does histology matter? Clinicopathologic and treatment patterns in esophageal cancer. Paper presented at: Academic Surgical Congress; 2011 Feb 2; Huntington Beach, CA. [view]
  10. Sherman K, Merkow RP, Keswani RN, Bilimoria KY, Bentrem D. Early Gastric Adenocarcinoma: Utilization of Endoscopic Resection and Nodal Metastases Rates. Poster session presented at: Society of Surgical Oncology Cancer Annual Symposium; 2013 Mar 6; Washington, DC. [view]
  11. Merkow RP, Bentrem D, Chow W, Cohen M, Ko C, Bilimoria KY. Effect of post-operative complications on adjuvant chemotherapy use in stage III colon cancer. Paper presented at: Gastrointestinal Cancers Annual Symposium; 2012 Jan 20; San Francisco, CA. [view]
  12. Bilimoria KY, Wayne JD, Merkow DE, Abbott DE, Hunt KK, Pisters WT, Pollock R, Bentrem D. Evolution of multidisciplinary management of gastrointestinal stromal tumors in the United States. Paper presented at: Society of Surgical Oncology Cancer Annual Symposium; 2011 Mar 6; San Antonio, TX. [view]
  13. Ahmad SA, Sutton JM, Grewal SS, Kooby DA, Maithel SK, Bentrem D, Weber SM, Cho CS, Winslow ER, Scoggins CR, Martin RC, Kim HJ, Merchant NB, Parikh AA, Edwards MJ. Factors Influencing Readmission Following Pancreaticoduodenectomy: A Multi-Institutional Study of 1,302 Patients. Paper presented at: American Surgical Association Annual Meeting; 2012 May 1; San Francisco, CA. [view]
  14. Hayman A, Fischer M, Wang EC, Prinz R, Talamonti M, Hynes DM, Gordon HS, Bentrem D. Has regionalization improved outcomes for pancreatic resections in Illinois? Paper presented at: Academic Surgical Congress; 2010 Nov 11; Huntington Beach, CA. [view]
  15. Hayman A, Toto E, Pozgay DJ, Bentrem D, Brenner D. Impact of ethnicity and economic status on access to colon cancer screening. Paper presented at: American Gastroenterology Association Annual Meeting; 2011 May 10; Chicago, IL. [view]
  16. Merkow RP, Bilimoria KY, McCarter M, Ko CY, Bentrem D. Influence of operative approach and conduit type on short term outcomes after esophagectomy. Paper presented at: Academic Surgical Congress; 2012 Feb 15; Las Vegas, NV. [view]
  17. Merkow R, Sohn M, Ju M, Chung W, Bentrem D, Bilimoria K. Lack of adherence with quality guidelines for post-discharge venous thromboembolism prophylaxis after colorectal cancer surgery in the U.S. Paper presented at: Academic Surgical Congress; 2013 Feb 6; New Orleans, LA. [view]
  18. Sherman K, Shah A, Merkow RP, Wang CE, Bilimoria K, Bentrem D. Management of advanced gastric cancer in the United States: Analysis of 21,039 Patients. Paper presented at: Academic Surgical Congress; 2013 Feb 6; New Orleans, LA. [view]
  19. Merkow RP, Bilimoria KY, Tomlinson JS, Paruch JL, Ko CY, Bentrem D. Postoperative Complications Reduce Adjuvant Chemotherapy Use in Respectable Pancreatic Cancer. Paper presented at: Society of Surgical Oncology Cancer Annual Symposium; 2013 Mar 6; Washington, DC. [view]
  20. Merkow RP, Bilimoria KY, McCarter MD, Bentrem D. Real-World Perioperative Outcomes after Esophagectomy: Which Operative Approach Results in Fewer Complications? Paper presented at: Academic Surgical Congress; 2012 Feb 15; Las Vegas, NV. [view]
  21. Tarlov E, Lee TA, Weichle TW, Zhang Q, Perrin RA, Bentrem D, Hynes DM. Reduced Overall and Event-Free Survival Among Colon Cancer Patients Using Dual System Care. Paper presented at: VA HSR&D National Meeting; 2012 Jul 17; National Harbor, MD. [view]
  22. Phillips JD, Blatner NR, DeCamp MM, Heiferman J, Milad H, Bentrem D, Khazaie K. Regulatory T-cell subpopulations in patients with pulmonary adenocarcinoma. Paper presented at: Academic Surgical Congress; 2012 Feb 15; Las Vegas, NV. [view]
  23. Merkow RP, Bilimoria KY, Stewart A, Ko C, Bentrem D. Room for improvement? Assessment of Multimodal esophageal cancer care in the United States. Paper presented at: Society of Surgical Oncology Cancer Annual Symposium; 2011 Mar 5; San Antonio, TX. [view]
  24. Merkow RP, Bilimoria KY, McCarter MD, Phillips JD, DeCamp MM, Ko CY, Bentrem D. Short-Term Outcomes after Esophagectomy at 164 ACS NSQIP Hospitals: Effect of Operative Approach and Assessment of Variation in Hospital Performance. Paper presented at: Academic Surgical Congress; 2012 Feb 15; Las Vegas, NV. [view]
  25. Hayman A, Fischer M, Anaya B, Parachuri R, Bentrem D, Guihan M. Survey Colonoscopy is Safe in Veterans with Spinal Cord Injury or Disorder (SCI&D). Paper presented at: VA Association of Surgeons Annual Meeting; 2011 Apr 11; Irvine, CA. [view]
  26. Hayman A, Bentrem D, Prystowsky J. Survey of VA surgeon use and knowledge of the VASQIP mortality calculator. Paper presented at: VA Association of Surgeons Annual Meeting; 2011 Apr 11; Irvine, CA. [view]
  27. Tarlov E, Lee TA, Weichle TW, Durazo-Arvizu R, Zhang Q, Perrin RA, Bentrem D, Hynes DM. VA and Medicare dual healthcare system use: impacts on 3-year event free survival for colon cancer. Poster session presented at: American Society of Clinical Oncology Annual Meeting; 2011 Jun 6; Chicago, IL. [view]
  28. Bentrem D. Validation of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) New Readmission Variables. Paper presented at: American College of Surgeons National Surgical Quality Improvement Program Annual Meeting; 2012 Oct 5; Chicago, IL. [view]


DRA: Health Systems, Cancer, Digestive Diseases
DRE: Treatment - Observational, Research Infrastructure
Keywords: Surgery
MeSH Terms: none

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