Using the MBSAQIP PUF for Research

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1 Using the MBSAQIP PUF for Research Kristopher Huffman, MS Division of Research and Optimal Patient Care American College of Surgeons July 22 nd, 2017

2 I have no disclosures Disclosures

3 PUF = Participant Use File PUF PUFs are released annually CY 2015 PUF was released in January 2017 CY 2016 PUF will be released in Fall 2017 CY 2017 PUF will be released in Fall 2018 Etc.

4 PUF Case Volume 2015 PUF Cases performed in ,093 metabolic and bariatric surgical cases from 742 centers 2016 PUF Cases performed in ,772 metabolic and bariatric surgical cases from 791 centers

5 Accessing a PUF Or google MBSAQIP PUF

6 PUF Contents Main PUF Dataset Other PUF Datasets Reoperation Readmission BMI Intervention

7 PUF Contents Main PUF Dataset - All cases (each row represents a case) - Contains variables (demographics, preoperative patient characteristics, operative information, outcomes, and other case descriptors) for all cases - Contains ~ 135 variables (columns) Other PUF Datasets - Reoperations, readmissions, interventions, and post-op BMI measurements corresponding to cases in the Main dataset (each row represents a reoperation, readmission, intervention, or post-op BMI measurement, respectively) - Contain event specific variables - Contain ~ 10 variables (columns) per dataset

8 PUF Contents Main PUF Dataset - All cases (each row represents a case) Other PUF Datasets Reoperation Readmission BMI - Contains variables (demographics, preoperative patient characteristics, operative information, outcomes, and other case descriptors) for all cases Intervention - Contains ~ 135 variables (columns) Each observation in the Reoperation, Readmission, Intervention, and BMI datasets can be merged with a case in the Main PUF dataset using a key-matching variable.

9 SAS, SPSS, and.txt files Cases must have been included in the SAR (quality audit) PUF Features All variables are HIPAA compliant no protected health information (PHI) No absolute dates Dates converted to time intervals (e.g., discharge date is not given but days from operation to discharge is given) No provider IDs or pseudo-provider IDs 30-day Outcomes Missing predictor values (e.g., labs) are permitted Raw datasets users need to be prepared to clean and construct variables relevant to their particular research Variables that are included, definitions, and status as mandatory, change over time. Centers with < 80% complete 30-day follow-up are excluded from the SAR You should always consult the PUF User Guide for the particular year(s) you are studying.

10 PUF User Guide

11 Accessing the PUF User Guide Or google MBSAQIP PUF

12 Research Opportunities Highly focused, clinically-driven models for patient outcomes What patient factors are related to an outcome? How are they related? Can you predict the outcome based on these factors? Evaluate changes in postoperative outcomes over time Or you can just look at the current state Compare outcomes for Competing operations Different patient risk groups

13 Research Potential The MBSAQIP PUF has to potential to become a preeminent resource for evidence-based surgical outcomes research in the field of metabolic and bariatric surgery. Large N (> 150,000 cases) 100% capture of all metabolic and bariatric procedures at the participating institutions Variables (predictors and outcomes) designed by experts in the field of metabolic and bariatric surgery

14 Publications 22 abstract submissions were submitted for the MBSAQIP track at this conference Abstract Session 6: MBSAQIP Abstracts (Sunday, 2:30 4)

15 Research Limitations No evaluation of time-of-day or day-of-week effects No provider (hospital or surgeon) profiling Cannot evaluate hospital-level variables No longitudinal analyses There may be logical gray areas or inconsistencies

16 1. Define the research question 2. Examine PUF User Guides PUF Research Steps 3. Determine if/how your research question could be answered with a PUF 4. Acquire PUF 5. Identify statistical resources (software and expertise). Are you able to: Access the file using appropriate statistical software? Select/impute/transform/construct variables? Justify and invoke appropriate statistical analyses? Identify statistical assumptions/problems/solutions? Interpret results? Unfortunately, MBSAQIP statistical support for extramural researchers is limited. We don t give formal guidance about how you should do these things likely to be research-specific.

17 PUF Research Steps If age > 80 we set age equal to missing BUT There is an indicator variable (agegt80) to identify such cases

18 1. Define the research question 2. Examine PUF User Guides PUF Research Steps 3. Determine if/how your research question could be answered with a PUF 4. Acquire PUF 5. Identify statistical resources (software and expertise). Are you able to: Access the file using appropriate statistical software? Select/impute/transform/construct variables? Justify and invoke appropriate statistical analyses? Identify statistical assumptions/problems/solutions? Interpret results? Unfortunately, MBSAQIP statistical support for extramural researchers is limited. We don t give formal guidance about how you should do these things likely to be research-specific.

19 PUF Research Steps Main PUF Dataset Other PUF Datasets Reoperation BMI Readmission Intervention

20 PUF Research Steps Main PUF Dataset Other PUF Datasets 2. Merge with the Main dataset 1. Identify cases with a related readmission Readmission

21 PUF Research Steps Main PUF Dataset Other PUF Datasets Reoperation 1. Identify cases with a reoperation for leak Readmission 2. Identify cases with a readmission for leak Intervention 3. Identify cases with an intervention for leak 5. Merge with Main dataset 4. Combine these cases

22 1. Define the research question 2. Examine PUF User Guides PUF Research Steps 3. Determine if/how your research question could be answered with a PUF 4. Acquire PUF 5. Identify statistical resources (software and expertise). Are you able to: Access the file using appropriate statistical software? Select/impute/transform/construct variables? Justify and invoke appropriate statistical analyses? Identify statistical assumptions/problems/solutions? Interpret results? Unfortunately, MBSAQIP statistical support for extramural researchers is limited. We don t give formal guidance about how you should do these things likely to be research-specific.

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