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Hsiao V, Kazaure HS, Drake FT, Inabnet WB, Rosen JE, Davenport DL, Schneider DF. A comparison of NSQIP and CESQIP in data quality and ability to predict thyroidectomy outcomes. Surgery 2023; 173:215-225. [PMID: 36402607 DOI: 10.1016/j.surg.2022.05.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Collaborative Endocrine Surgery Quality Improvement Program tracks thyroidectomy outcomes with self-reported data, whereas the National Surgical Quality Improvement Program uses professional abstractors. We compare completeness and predictive ability of these databases at a single-center and national level. METHOD Data consistency in the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program at a single institution (2013-2020) was evaluated using McNemar's test. At the national level, data from the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program (2016-2019) were used to compare predictive capability for 4 outcomes within each data source: thyroidectomy-specific complication, systemic complication, readmission, and reoperation, as measured by area under curve. RESULTS In the single-center analysis, 66 cases were recorded in both the Collaborative Endocrine Surgery Quality Improvement Program and the National Surgical Quality Improvement Program. The reoperation variable had the most discrepancies (2 vs 0 in the National Surgical Quality Improvement Program versus the Collaborative Endocrine Surgery Quality Improvement Program, respectively; χ2 = 2.00, P = .16). At the national level, there were 24,942 cases in the National Surgical Quality Improvement Program and 17,666 cases in the Collaborative Endocrine Surgery Quality Improvement Program. In the National Surgical Quality Improvement Program, 30-day thyroidectomy-specific complication, systemic complication, readmission, and reoperation were 13.25%, 2.13%, 1.74%, and 1.39%, respectively, and in the Collaborative Endocrine Surgery Quality Improvement Program 7.27%, 1.95%, 1.64%, and 0.81%. The area under curve of the National Surgical Quality Improvement Program was higher for predicting readmission (0.721 [95% confidence interval 0.703-0.737] vs 0.613 [0.581-0.649]); the area under curve of the Collaborative Endocrine Surgery Quality Improvement Program was higher for thyroidectomy-specific complication (0.724 [0.708-0.737] vs 0.677 [0.667-0.687]) and reoperation (0.735 [0.692-0.775] vs 0.643 [0.611-0.673]). Overall, 3.44% vs 27.22% of values were missing for the National Surgical Quality Improvement Program and the Collaborative Endocrine Surgery Quality Improvement Program, respectively. CONCLUSION The Collaborative Endocrine Surgery Quality Improvement Program was more accurate in predicting thyroidectomy-specific complication and reoperation, underscoring its role in collecting granular, disease-specific variables. However, a higher proportion of data are missing. The National Surgical Quality Improvement Program infrastructure leads to more rigorous data capture, but the Collaborative Endocrine Surgery Quality Improvement Program is better at predicting thyroid-specific outcomes.
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Affiliation(s)
- Vivian Hsiao
- Department of Surgery, University of Wisconsin-Madison, Madison, WI.
| | - Hadiza S Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frederick T Drake
- Department of Endocrine Surgery, Boston Medical Center, Boston, Massachusetts
| | | | | | | | - David F Schneider
- Department of Surgery, University of Wisconsin-Madison, Madison, WI; Division of Endocrine Surgery, University of Wisconsin-Madison, Madison, WI
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Massa I, Ghignone F, Ugolini G, Ercolani G, Montroni I, Capelli P, Garulli G, Catena F, Lucchi A, Ansaloni L, Gentili N, Danesi V, Montella MT, Altini M. Emilia-Romagna Surgical Colorectal Cancer Audit (ESCA): a value-based healthcare retro-prospective study to measure and improve the quality of surgical care in colorectal cancer. Int J Colorectal Dis 2022; 37:1727-1738. [PMID: 35779080 PMCID: PMC9262771 DOI: 10.1007/s00384-022-04203-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgery is the main treatment for non-metastatic colorectal cancer. Despite huge improvements in perioperative care, colorectal surgery is still associated with a significant burden of postoperative complications and ultimately costs for healthcare organizations. Systematic clinical auditing activity has already proven to be effective in measuring and improving clinical outcomes, and for this reason, we decided to evaluate its impact in a large area of northern Italy. METHODS The Emilia-Romagna Surgical Colorectal Audit (ESCA) is an observational, multicentric, retro-prospective study, carried out by 7 hospitals located in the Emilia-Romagna region. All consecutive patients undergoing surgery for colorectal cancer during a 54-month study period will be enrolled. Data regarding baseline conditions, preoperative diagnostic work-up, surgery and postoperative course will be collected in a dedicated case report form. Primary outcomes regard postoperative complications and mortality. Secondary outcomes include each center's adherence to the auditing (enrolment rate) and evaluation of the systematic feedback activity on key performance indicators for the entire perioperative process. CONCLUSION This protocol describes the methodology of the Emilia-Romagna Surgical Colorectal Audit. The study will provide real-world clinical data essential for benchmarking and feedback activity, to positively impact outcomes and ultimately to improve the entire healthcare process of patients undergoing colorectal cancer surgery. CLINICAL TRIAL REGISTRATION The study ESCA is registered on the clinicaltrials.gov platform (Identifier: NCT03982641).
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Affiliation(s)
- Ilaria Massa
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST) “ Dino Amadori”, Meldola, Italy
| | - Federico Ghignone
- U.O. Chirurgia Generale, Hospital “Santa Maria delle Croci”, AUSL, Ravenna, Romagna Italy
| | - Giampaolo Ugolini
- U.O. Chirurgia Generale, Hospital “Santa Maria delle Croci”, AUSL, Ravenna, Romagna Italy
| | - Giorgio Ercolani
- U.O. Chirurgia Generale e Terapie Oncologiche avanzate, Hospital “GB. Morgagni-L.Pierantoni”, AUSL, Forli, Romagna Italy
| | - Isacco Montroni
- U.O Chirurgia Generale, Hospital “degli Infermi”, AUSL, Faenza, Romagna Italy
| | - Patrizio Capelli
- Department of Surgery, Hospital “G. Da Saliceto”, Piacenza, AUSL, Piacenza, Italy
| | - Gianluca Garulli
- U.O. Chirurgia Generale, Hospital “Infermi”, AUSL, Rimini, Romagna Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, AUSL, Cesena, Romagna Italy
| | - Andrea Lucchi
- U.O. Chirurgia Generale, Hospital “Ceccarini”, AUSL, Riccione, Romagna Italy
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Nicola Gentili
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST) “ Dino Amadori”, Meldola, Italy
| | - Valentina Danesi
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST) “ Dino Amadori”, Meldola, Italy
| | - Maria Teresa Montella
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST) “ Dino Amadori”, Meldola, Italy
| | - Mattia Altini
- Healthcare Administration, AUSL of Romagna, Ravenna, Italy
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Fischer CP, Hu QL, Wescott AB, Maggard-Gibbons M, Hoyt DB, Ko CY. Evidence Review for the American College of Surgeons Quality Verification Part II: Processes for Reliable Quality Improvement. J Am Coll Surg 2021; 233:294-311.e1. [PMID: 33940183 DOI: 10.1016/j.jamcollsurg.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/21/2022]
Abstract
After decades of experience supporting surgical quality and safety by the American College of Surgeons, the American College of Surgeons Quality Verification Program was developed to help hospitals improve surgical quality, safety, and reliability. This review is the second of a 3-part review aiming to synthesize the evidence supporting the main principles of the American College of Surgeons Quality Verification Program. Evidence was systematically reviewed for 5 principles: case review, peer review, credentialing and privileging, data for surveillance, and continuous quality improvement using data. MEDLINE was searched for articles published from inception to January 2019 and 2 reviewers independently screened studies for inclusion in a hierarchical fashion, extracted data, and summarized results in a narrative fashion. A total of 9,098 studies across the 5 principles were identified. After exclusion criteria, a total of 184 studies in systematic reviews and primary studies were included for assessment. The identified literature supports the importance of standardized processes and systems to identify problems and improve quality of care.
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Affiliation(s)
- Chelsea P Fischer
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Q Lina Hu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Annie B Wescott
- Galter Library & Learning Center, Feinberg School of Medicine, Northwestern University, Chicago
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - David B Hoyt
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; THIS Institute, University of Cambridge, UK
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4
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Brajcich BC, Fischer CP, Ko CY. Administrative and Registry Databases for Patient Safety Tracking and Quality Improvement. Surg Clin North Am 2021; 101:121-134. [DOI: 10.1016/j.suc.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Somani S, Di Capua J, Kim JS, Kothari P, Lee NJ, Leven DM, Cho SK. Comparing National Inpatient Sample and National Surgical Quality Improvement Program: An Independent Risk Factor Analysis for Risk Stratification in Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2017; 42:565-572. [PMID: 27513227 DOI: 10.1097/brs.0000000000001850] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of prospectively collected data. OBJECTIVE To explore interdatabase reliability between National Inpatient Sample (NIS) and National Surgical Quality Improvement Program (NSQIP) for anterior cervical discectomy and fusion (ACDF) in data collection and its impact on subsequent statistical analyses. SUMMARY OF BACKGROUND DATA Clinical studies in orthopedics using national databases are ubiquitous, but analytical differences across databases are largely unexplored. METHODS A retrospective cohort study of patients undergoing ACDF surgery was performed in NIS and NSQIP. Key demographic variables, comorbidities, intraoperative characteristics, and postoperative complications were analyzed via bivariate and multivariate analyses. RESULTS A total of 112,162 patients were identified from NIS and 10,617 from NSQIP. Bivariate analysis revealed small, but significant, differences between patient demographics, whereas patient comorbidities and ACDF intraoperative variables were largely much more distinct across the two databases. Multivariate analysis identified independent risk factors between NIS and NSQIP for mortality, cardiac complications, and postoperative sepsis, some of which were identified in both but most of which were unique to one database. Identification of independent risk factors from both databases specifically highlights their greater validity and importance in stratifying patient risks. In addition, NSQIP was found to be a more accurate predictor for complications based on the average areas under the receiver-operating curve (CNSQIP = 0.83 vs. CNIS = 0.81) across the multivariate models. Complication rate analysis between inpatient and outpatient settings in NSQIP showed the importance of at least 30-day patient follow up, which was devoid in NIS data tabulation and further marked its weakness compared with NSQIP. CONCLUSION Despite having largely similar patient demographics, this study highlights critical risk factors for ACDF and demonstrates how different patient profiles can be across NIS and NSQIP, the impact of such differences on identification of independent risk factors, and how NSQIP is ultimately better suited for adverse-event studies. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Sulaiman Somani
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Impacts of structuring the electronic health record: Results of a systematic literature review from the perspective of secondary use of patient data. Int J Med Inform 2017; 97:293-303. [DOI: 10.1016/j.ijmedinf.2016.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
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Rodrigo-Rincón I, Martin-Vizcaíno MP, Tirapu-León B, Zabalza-López P, Abad-Vicente FJ, Merino-Peralta A, Oteiza-Martínez F. Usefulness of administrative databases for risk adjustment of adverse events in surgical patients. Cir Esp 2015; 94:165-74. [PMID: 25841880 DOI: 10.1016/j.ciresp.2015.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/20/2014] [Accepted: 01/10/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. METHODS The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. RESULTS The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CONCLUSION CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients.
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Affiliation(s)
- Isabel Rodrigo-Rincón
- Departamento de Medicina Preventiva y Control de la Calidad, Complejo Hospitalario de Navarra, Servicio Navarro de Salud; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España.
| | | | - Belén Tirapu-León
- Departamento de Medicina Preventiva y Control de la Calidad, Complejo Hospitalario de Navarra, Servicio Navarro de Salud
| | - Pedro Zabalza-López
- Departamento de Medicina Preventiva y Control de la Calidad, Complejo Hospitalario de Navarra, Servicio Navarro de Salud
| | - Francisco J Abad-Vicente
- Departamento de Medicina Preventiva y Control de la Calidad, Complejo Hospitalario de Navarra, Servicio Navarro de Salud
| | | | - Fabiola Oteiza-Martínez
- Departamento de Cirugía General, Complejo Hospitalario de Navarra, Servicio Navarro de Salud
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Lee MK, Lewis RS, Strasberg SM, Hall BL, Allendorf JD, Beane JD, Behrman SW, Callery MP, Christein JD, Drebin JA, Epelboym I, He J, Pitt HA, Winslow E, Wolfgang C, Vollmer CM. Defining the post-operative morbidity index for distal pancreatectomy. HPB (Oxford) 2014; 16:915-23. [PMID: 24931404 PMCID: PMC4238858 DOI: 10.1111/hpb.12293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate assessment of complications is critical in analysing surgical outcomes. The post-operative morbidity index (PMI), derived from the Modified Accordion Severity Grading System and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), is a quantitative measure of post-operative morbidity. This study utilizes PMI to establish the complication burden for a distal pancreatectomy (DP). METHODS From 2005-2011, nine centres contributed ACS-NSQIP complication data for 655 DPs. Each complication was assigned an Accordion severity weight ranging from 0.11 for grade 1 to 1.00 for grade 6 (death). The PMI is the sum of complication severity weights divided by the total number of patients. RESULTS ACS-NSQIP complications occurred in 177 patients (27.0%). The non risk-adjusted PMI for DP is 0.087. Bleeding/Transfusion and Organ Space Infection were the most common complications. Frequency and burden differed across Accordion grades. While grade 4-6 complications represented only 15.4% of complication occurrences, they accounted for 30.4% of the burden. Subgroup analysis demonstrates that the PMI did not vary based on laparoscopic versus open approach or the performance of a splenectomy. DISCUSSION This study uses two validated systems to quantitatively establish the morbidity of a DP. The PMI allows estimation of both the frequency and severity of complications and thus provides a more comprehensive assessment of risk.
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Affiliation(s)
- Major K Lee
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
| | - Russell S Lewis
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
| | - Steven M Strasberg
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
| | - Bruce L Hall
- Department of Surgery, Washington University in St. Louis School of MedicineMO, USA
- Department of Surgery, Olin Business School and the Center for Health Policy, Washington University in St. LouisMO, USA
| | - John D Allendorf
- Department of Surgery, Columbia University School of MedicineNew York, NY, USA
| | - Joal D Beane
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
| | - Stephen W Behrman
- Department of Surgery, University of Tennessee Health Science CenterMemphis, TN, USA
| | - Mark P Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical SchoolBoston, MA, USA
| | - John D Christein
- Department of Surgery, University of Alabama at Birmingham School of MedicineBirmingham, AL, USA
| | - Jeffrey A Drebin
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
| | - Irene Epelboym
- Department of Surgery, Columbia University School of MedicineNew York, NY, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Henry A Pitt
- Department of Surgery, Indiana University School of MedicineIndianapolis, IN, USA
- Department of Surgery, Temple University School of MedicinePhiladelphia, PA, USA
| | - Emily Winslow
- Department of Surgery, University of Wisconsin School of MedicineMadison, WI, USA
| | - Christopher Wolfgang
- Department of Surgery, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | - Charles M Vollmer
- Department of Surgery, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA, USA
- Correspondence: Charles M. Vollmer Jr, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA. Tel: +1 215 349 8516. Fax: +1 215 349 8195. E-mail:
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Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MPW. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology 2014; 119:959-81. [PMID: 24195875 DOI: 10.1097/aln.0b013e3182a4e94d] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Risk stratification is essential for both clinical risk prediction and comparative audit. There are a variety of risk stratification tools available for use in major noncardiac surgery, but their discrimination and calibration have not previously been systematically reviewed in heterogeneous patient cohorts.Embase, MEDLINE, and Web of Science were searched for studies published between January 1, 1980 and August 6, 2011 in adult patients undergoing major noncardiac, nonneurological surgery. Twenty-seven studies evaluating 34 risk stratification tools were identified which met inclusion criteria. The Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality and the Surgical Risk Scale were demonstrated to be the most consistently accurate tools that have been validated in multiple studies; however, both have limitations. Future work should focus on further evaluation of these and other parsimonious risk predictors, including validation in international cohorts. There is also a need for studies examining the impact that the use of these tools has on clinical decision making and patient outcome.
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Affiliation(s)
- Suneetha Ramani Moonesinghe
- * Director, University College London, University College London Hospitals' Surgical Outcomes Research Center, London, United Kingdom; Honorary Senior Lecturer, University College London; and Consultant, Anaesthesia and Critical Care, University College Hospital. † Professor, Smiths Medical Professor of Anaesthesia and Critical Care, University College London; and Honorary Consultant, Anaesthesia, University College Hospital. ‡ Research Fellow, University College London, University College London Hospitals' Surgical Outcomes Research Center, University College Hospital. § Professor and Director, Intensive Care National Audit and Research Center, London, United Kingdom. ‖ Professor of Critical Care Medicine, University of Southampton, Southampton, United Kingdom; Honorary Consultant, Critical Care, Southampton University Hospital; and Director, National Institute for Academic Anaesthesia's Health Services Research Center, London, United Kingdom
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Siregar S, Pouw ME, Moons KGM, Versteegh MIM, Bots ML, van der Graaf Y, Kalkman CJ, van Herwerden LA, Groenwold RHH. The Dutch hospital standardised mortality ratio (HSMR) method and cardiac surgery: benchmarking in a national cohort using hospital administration data versus a clinical database. Heart 2013; 100:702-10. [PMID: 24334377 PMCID: PMC3995286 DOI: 10.1136/heartjnl-2013-304645] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the accuracy of data from hospital administration databases and a national clinical cardiac surgery database and to compare the performance of the Dutch hospital standardised mortality ratio (HSMR) method and the logistic European System for Cardiac Operative Risk Evaluation, for the purpose of benchmarking of mortality across hospitals. Methods Information on all patients undergoing cardiac surgery between 1 January 2007 and 31 December 2010 in 10 centres was extracted from The Netherlands Association for Cardio-Thoracic Surgery database and the Hospital Discharge Registry. The number of cardiac surgery interventions was compared between both databases. The European System for Cardiac Operative Risk Evaluation and hospital standardised mortality ratio models were updated in the study population and compared using the C-statistic, calibration plots and the Brier-score. Results The number of cardiac surgery interventions performed could not be assessed using the administrative database as the intervention code was incorrect in 1.4–26.3%, depending on the type of intervention. In 7.3% no intervention code was registered. The updated administrative model was inferior to the updated clinical model with respect to discrimination (c-statistic of 0.77 vs 0.85, p<0.001) and calibration (Brier Score of 2.8% vs 2.6%, p<0.001, maximum score 3.0%). Two average performing hospitals according to the clinical model became outliers when benchmarking was performed using the administrative model. Conclusions In cardiac surgery, administrative data are less suitable than clinical data for the purpose of benchmarking. The use of either administrative or clinical risk-adjustment models can affect the outlier status of hospitals. Risk-adjustment models including procedure-specific clinical risk factors are recommended.
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Affiliation(s)
- S Siregar
- Department of Cardio-Thoracic Surgery, University Medical Centre Utrecht, , Utrecht, The Netherlands
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Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 2013; 27:3555-63. [PMID: 23584820 DOI: 10.1007/s00464-013-2949-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/22/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed. METHODS We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC. RESULTS A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07-1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12-1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39-0.53]. CONCLUSIONS Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.
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Jang WM, Park JH, Park JH, Oh JH, Kim Y. Improving the performance of risk-adjusted mortality modeling for colorectal cancer surgery by combining claims data and clinical data. J Prev Med Public Health 2013; 46:74-81. [PMID: 23573371 PMCID: PMC3615382 DOI: 10.3961/jpmph.2013.46.2.74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/19/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery. METHODS We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration. RESULTS The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1. CONCLUSIONS The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.
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Affiliation(s)
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University, Suwon, Korea
| | - Jong-Hyock Park
- Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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Bruny J, Ziegler MM. Historical development of pediatric surgical quality: the first 100 years. Adv Pediatr 2013; 60:281-94. [PMID: 24007849 DOI: 10.1016/j.yapd.2013.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer Bruny
- Department of Surgery, Children's Hospital of Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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Resident Participation in Index Laparoscopic General Surgical Cases: Impact of the Learning Environment on Surgical Outcomes. J Am Coll Surg 2013; 216:96-104. [DOI: 10.1016/j.jamcollsurg.2012.08.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/10/2012] [Accepted: 08/14/2012] [Indexed: 12/21/2022]
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15
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Advani V, Ahad S, Gonczy C, Markwell S, Hassan I. Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP. Am J Surg 2012; 203:347-51; discussion 351-2. [PMID: 22364902 DOI: 10.1016/j.amjsurg.2011.08.015] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Controversy exists regarding whether resident involvement during surgery impacts patient outcomes. We compared surgical times and perioperative complications of patients undergoing laparoscopic appendectomy with and without residents. METHODS Patients undergoing laparoscopic appendectomy for uncomplicated acute appendicitis during 2005 to 2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. RESULTS During the study period, 16,849 patients underwent laparoscopic appendectomy for uncomplicated appendicitis (residents participated in 68% of procedures). There were no statistical and/or clinically meaningful differences between median age, sex, body mass index, American Society of Anesthesiology score, and morbidity probability between the 2 groups, suggesting that case mix was not a significant confounder. Patients undergoing laparoscopic appendectomy with residents compared with patients undergoing laparoscopic appendectomy without residents had a higher incidence of serious and overall morbidity and longer surgical times. However, surgical times and complications were similar between residents in postgraduate years 1 to 5. CONCLUSIONS Regardless of the postgraduate year level, resident involvement resulted in a clinically appreciable increase in surgical times and a statistically significant increase in certain complications.
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Affiliation(s)
- Vriti Advani
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62704, USA
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16
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What Are the Real Rates of Postoperative Complications: Elucidating Inconsistencies Between Administrative and Clinical Data Sources. J Am Coll Surg 2012; 214:798-805. [DOI: 10.1016/j.jamcollsurg.2011.12.037] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022]
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17
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Lee LC, Reines HD, Sheridan MJ, Farmer BE, Martin J, Duan M. Apples and oranges: comparison of ACS-NSQIP observed outcomes with premier's quality manager-predicted outcomes. Am J Med Qual 2011; 26:474-9. [PMID: 21835812 DOI: 10.1177/1062860611401652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The National Surgical Quality Improvement Program (NSQIP) is used by the American College of Surgeons to measure and report surgical quality and outcomes. Premier's Quality Manager (QM) generates expected outcomes from patient charts. The authors compared observed NSQIP morbidity and mortality outcomes with those predicted by QM. NSQIP data for 1919 patients were entered into QM. The discriminatory accuracy of the QM model was assessed using the C statistic (1.0 implies perfect discrimination, and 0.5 implies no discrimination). NSQIP and QM both identified 51 deaths (C statistic, 0.91). NSQIP identified 478 postoperative occurrences, whereas QM predicted 714 patients with at least 1 complication; 223 of these were subclassified as patients with at least 1 morbid complication (C statistic, 0.83). QM did not perform as well in predicting the observed NSQIP morbidities. Surgical leaders and hospital administrators must critically evaluate products before adopting programs designed to improve patient outcomes or making decisions regarding physician practice.
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Affiliation(s)
- Louis C Lee
- Dept. of Surgery, Inova Fairfax Hospital, Falls Church, VA 22151, USA
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18
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Surgical Resident Involvement Is Safe for Common Elective General Surgery Procedures. J Am Coll Surg 2011; 213:19-26; discussion 26-8. [DOI: 10.1016/j.jamcollsurg.2011.03.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 01/31/2023]
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19
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Schramm DR, Worthington JR, Kitts JB. Implementation of an integrated peri-operative quality management program at the Ottawa Hospital. Healthc Manage Forum 2011; 24:S34-S48. [PMID: 21717948 DOI: 10.1016/j.hcmf.2011.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The 2004 Canadian Adverse Events Study estimated up to 23,750 potentially preventable in-hospital deaths occur annually; 51.4% of adverse events occurred with surgical care delivery. An integrated peri-operative quality management program has been implemented at The Ottawa Hospital using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Using root cause analysis within a Plan-Do-Study-Act process improvement cycle, NSQIP will lead to improved peri-operative outcomes at the largest Canadian academic healthcare organization.
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Affiliation(s)
- David R Schramm
- The Ottawa Hospital, Civic Parkdale Clinic, 121-737 Parkdale Avenue, Ottawa, Ontario, Canada K1Y 1J8.
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20
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Understanding the effect of obesity on patient outcomes after cancer surgery. J Surg Res 2010; 166:214-6. [PMID: 20655061 DOI: 10.1016/j.jss.2010.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 04/04/2010] [Accepted: 04/13/2010] [Indexed: 11/22/2022]
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21
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Keroack MA, Meurer SJ. Predicted risk of mortality models. J Am Coll Surg 2010; 210:1016-8; author reply 1018. [PMID: 20510820 DOI: 10.1016/j.jamcollsurg.2010.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
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22
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Quantitative Weighting of Postoperative Complications Based on the Accordion Severity Grading System: Demonstration of Potential Impact Using the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210:286-98. [DOI: 10.1016/j.jamcollsurg.2009.12.004] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 11/25/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022]
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23
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Keroack MA, Meurer SJ, Sabel AL. Neurosurgical mortality rates. J Neurosurg 2010; 112:470; author reply 470-1. [PMID: 20121377 DOI: 10.3171/2009.10.jns091530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Hall BL, Richards K, Ingraham A, Ko CY. New approaches to the National Surgical Quality Improvement Program: the American College of Surgeons experience. Am J Surg 2010; 198:S56-62. [PMID: 19874936 DOI: 10.1016/j.amjsurg.2009.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/21/2009] [Indexed: 11/19/2022]
Abstract
In honor of the seminal contributions of Dr. Shukri Khuri to the foundation and development of the National Surgical Quality Improvement Program (NSQIP), a review of recent work and new directions within the American College of Surgeons (ACS) NSQIP is presented, according to the following outline:
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Affiliation(s)
- Bruce L Hall
- Department of Surgery, St. Louis Veterans Affairs Medical Center, and Department of Surgery, Olin Business School, and Center for Health Policy, Washington University in St. Louis, St. Louis, MO, USA.
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25
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Vogel TR, Dombrovskiy VY, Carson JL, Haser PB, Lowry SF, Graham AM. Infectious complications after elective vascular surgical procedures. J Vasc Surg 2010; 51:122-9; discussion 129-30. [DOI: 10.1016/j.jvs.2009.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/03/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
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26
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Lee DW, Foster DA. The Association Between Hospital Outcomes and Diagnostic Imaging: Early Findings. J Am Coll Radiol 2009; 6:780-5. [DOI: 10.1016/j.jacr.2009.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 08/03/2009] [Indexed: 11/16/2022]
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Adjusted or unadjusted outcomes. Am J Surg 2009; 198:S28-35. [DOI: 10.1016/j.amjsurg.2009.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/23/2009] [Accepted: 08/03/2009] [Indexed: 12/19/2022]
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Abstract
Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired. One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care. The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.
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Affiliation(s)
- Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143, USA.
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29
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Keroack MA, Meurer SJ. Database Duels Do Not Advance Quality Improvement. Am J Med Qual 2009; 24:444-6. [DOI: 10.1177/1062860609345453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tsai CL, Clark S, Sullivan AF, Camargo CA. Development and validation of a risk-adjustment tool in acute asthma. Health Serv Res 2009; 44:1701-17. [PMID: 19619246 DOI: 10.1111/j.1475-6773.2009.00998.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To develop and prospectively validate a risk-adjustment tool in acute asthma. DATA SOURCES Data were obtained from two large studies on acute asthma, the Multicenter Airway Research Collaboration (MARC) and the National Emergency Department Safety Study (NEDSS) cohorts. Both studies involved >60 emergency departments (EDs) and were performed during 1996-2001 and 2003-2006, respectively. Both included patients aged 18-54 years presenting to the ED with acute asthma. STUDY DESIGN Retrospective cohort studies. DATA COLLECTION Clinical information was obtained from medical record review. The risk index was derived in the MARC cohort and then was prospectively validated in the NEDSS cohort. PRINCIPLE FINDINGS There were 3,515 patients in the derivation cohort and 3,986 in the validation cohort. The risk index included nine variables (age, sex, current smoker, ever admitted for asthma, ever intubated for asthma, duration of symptoms, respiratory rate, peak expiratory flow, and number of beta-agonist treatments) and showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.75) and calibration ( p=.30 for Hosmer-Lemeshow test) when applied to the validation cohort. CONCLUSIONS We developed and validated a novel risk-adjustment tool in acute asthma. This tool can be used for health care provider profiling to identify outliers for quality improvement purposes.
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Affiliation(s)
- Chu-Lin Tsai
- EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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Davenport DL, Holsapple CW, Conigliaro J. Assessing Surgical Quality Using Administrative and Clinical Data Sets: A Direct Comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program Data Set. Am J Med Qual 2009; 24:395-402. [DOI: 10.1177/1062860609339936] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Daniel L. Davenport
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky,
| | - Clyde W. Holsapple
- Decision Science and Information Systems Area, University of Kentucky School of Management, Lexington, Kentucky
| | - Joseph Conigliaro
- Center for Enterprise Quality and Safety, University of Kentucky Chandler Medical Center, Lexington, Kentucky
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Goodney PP, Beck AW, Nagle J, Welch HG, Zwolak RM. National trends in lower extremity bypass surgery, endovascular interventions, and major amputations. J Vasc Surg 2009; 50:54-60. [PMID: 19481407 DOI: 10.1016/j.jvs.2009.01.035] [Citation(s) in RCA: 507] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/02/2009] [Accepted: 01/09/2009] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Advances in endovascular interventions have expanded the options available for the invasive treatment of lower extremity peripheral arterial disease (PAD). Whether endovascular interventions substitute for conventional bypass surgery or are simply additive has not been investigated, and their effect on amputation rates is unknown. METHODS We sought to analyze trends in lower extremity endovascular interventions (angioplasty and atherectomy), lower extremity bypass surgery, and major amputation (above and below-knee) in Medicare beneficiaries between 1996 and 2006. We used 100% samples of Medicare Part B claims to calculate annual procedure rates of lower extremity bypass surgery, endovascular interventions (angioplasty and atherectomy), and major amputation between 1996 and 2006. Using physician specialty identifiers, we also examined trends in the specialty performing the primary procedure. RESULTS Between 1996 and 2006, the rate of major lower extremity amputation declined significantly (263 to 188 per 100,000; risk ratio [RR] 0.71, 95% confidence interval [CI] 0.6-0.8). Endovascular interventions increased more than threefold (from 138 to 455 per 100,000; RR = 3.30; 95% CI: 2.9-3.7) while bypass surgery decreased by 42% (219 to 126 per 100,000; RR = 0.58; 95% CI: 0.5-0.7). The increase in endovascular interventions consisted both of a growth in peripheral angioplasty (from 135 to 337 procedures per 100,000; RR = 2.49; 95% CI: 2.2-2.8) and the advent of percutaneous atherectomy (from 3 to 118 per 100,000; RR = 43.12; 95% CI: 34.8-52.0). While radiologists performed the majority of endovascular interventions in 1996, more than 80% were performed by cardiologists and vascular surgeons by 2006. Overall, the total number of all lower extremity vascular procedures almost doubled over the decade (from 357 to 581 per 100,000; RR = 1.63; 95% CI: 1.5-1.8). CONCLUSION Endovascular interventions are now performed much more commonly than bypass surgery in the treatment of lower extremity PAD. These changes far exceed simple substitution, as more than three additional endovascular interventions were performed for every one procedure declined in lower extremity bypass surgery. During this same time period, major lower extremity amputation rates have fallen by more than 25%. However, further study is needed before any causal link can be established between lower extremity vascular procedures and improved rates of limb salvage in patients with PAD.
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Kates M, Perez X, Gribetz J, Swanson SJ, McGinn T, Wisnivesky JP. Validation of a Model to Predict Perioperative Mortality from Lung Cancer Resection in the Elderly. Am J Respir Crit Care Med 2009; 179:390-5. [DOI: 10.1164/rccm.200808-1342oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Steinberg SM, Popa MR, Michalek JA, Bethel MJ, Ellison EC. Comparison of risk adjustment methodologies in surgical quality improvement. Surgery 2008; 144:662-7; discussion 662-7. [PMID: 18847652 DOI: 10.1016/j.surg.2008.06.010] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 06/06/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND All hospitals are required to perform quality assurance activities. Many risk adjustment methodologies have been developed, and many medical centers use 1 or more than 1 risk adjustment program in an attempt to characterize their outcomes better rather than simply assessing unadjusted outcome statistics. The University HealthSystem Consortium (UHC) and American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) both produce risk-adjusted outcome data. Our institution recognized a large disparity between our UHC and NSQIP risk-adjusted mortality. The purpose of this study was to attempt to discover the cause of that disparity. METHODS One hundred twenty consecutive NSQIP records were matched with their UHC submissions during 2006. All patients' comorbidities and outcomes were reviewed, and the 2 systems, UHC and NSQIP, were compared for degree of discordance. RESULTS Approximately twice the number of comorbidities per patient were documented in UHC (2.85+/-2.52) submissions compared with NSQIP (1.38+/-1.52, P < .001). The reporting of the comorbidities of hypertension, cardiac disease, pulmonary disease, and diabetes between UHC and NSQIP were similar in the percentage of patients reported as having each of those disease states, but the discordance between the 2 systems was 12%, 13%, 15%, and 5%, respectively (P < .001 in all 4). A total of 28% of patients were reported as suffering complications in NSQIP but only 11% in UHC, with a 26% rate of discordance (P < .01). Overall, 13% of patients were reported as having a surgical site infection in NSQIP, but only 1% in UHC. CONCLUSIONS We found significant differences in the reporting of both comorbidities and outcomes between our medical center's submissions to UHC and NSQIP in a consecutive series of patients. This may be at least partially responsible for the difference in the risk-adjusted mortality for our institution, as reported by UHC and NSQIP.
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Affiliation(s)
- Steven M Steinberg
- Department of Surgery Division of Critical Care, Trauma and Burn, Ohio State University, Columbus, Ohio, USA.
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Surgical outcomes research: a progression from performance audits, to assessment of administrative databases, to prospective risk-adjusted analysis - how far have we come? Curr Opin Pediatr 2008; 20:320-5. [PMID: 18475103 DOI: 10.1097/mop.0b013e3283005857] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This review focuses on how the assessment of surgical quality and safety has evolved from individual performance audits and morbidity and mortality reviews, to assessment of large administrative databases, to the current practice of prospective risk-adjusted analysis by a National Surgical Quality Improvement Program for children's surgical care. This evolution follows the natural availability of surgical outcome data and a national call for improved hospital care safety and quality. RECENT FINDINGS Two new advances in children's surgical care include the comparative use of national health record data compiled in administrative datasets and the use of a risk-adjusted assessment of children's surgical morbidity and mortality as assessed by a newly developed National Surgical Quality Improvement Program for children's operative care. The value and application of these two datasets are presented. SUMMARY The evolution of the assessment of surgical quality and safety will equip the surgeon with an optimal array of outcome assessment tools to assure the best in surgical quality and safety for the pediatric patient.
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Transparency: A Mandatory Requirement for Risk Models. J Am Coll Surg 2008; 206:1240-2; author reply 1242-5. [DOI: 10.1016/j.jamcollsurg.2008.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 02/08/2008] [Indexed: 11/17/2022]
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