1
|
Richardson A, Pang T, Hitos K, Toh JWT, Johnston E, Morgan G, Zeng M, Mazevska D, McElduff P. Comparison of administrative data and the American College of Surgeons National Surgical Quality Improvement Program data in a New South Wales Hospital. ANZ J Surg 2019; 90:734-739. [PMID: 31840381 DOI: 10.1111/ans.15482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The National Surgical Quality Improvement Program (NSQIP) is widely used in North America for benchmarking. In 2015, NSQIP was introduced to four New South Wales public hospitals. The aim of this study is to investigate the agreement between NSQIP and administrative data in the Australian setting; to compare the performance of models derived from each data set to predict 30-day outcomes. METHODS The NSQIP and administrative data variables were mapped to select variables available in both data sets where coding may be influenced by interpretation of the clinical information. These were compared for agreement. Logistic regression models were fitted to estimate the probability of adverse outcomes within 30 days. Models derived from NSQIP and administrative data were compared by receiver operating characteristic curve analysis. RESULTS A total of 2240 procedures over 21 months had matching records. Functional status demonstrated poor agreement (kappa 0.02): administrative data recorded only one (1%) patient with partial- or total-dependence as recorded by NSQIP data. The American Society of Anesthesiologists class demonstrated excellent agreement (kappa 0.91). Other perioperative variables demonstrated poor to fair agreement (kappa 0.12-0.61). Predictive model based on NSQIP data was excellent at predicting mortality but was less accurate for complications and readmissions. The NSQIP model was better in predicting mortality and complications (receiver operating characteristic curve 0.93 versus 0.87; P = 0.029 and 0.71 versus 0.64; P = 0.027). CONCLUSIONS There is poor agreement between NSQIP data and administrative data. Predictive models associated with NSQIP data were more accurate at predicting surgical outcomes than those from administrative data. To drive quality improvement in surgery, high-quality clinical data are required and we believe that NSQIP fulfils this function.
Collapse
Affiliation(s)
- Arthur Richardson
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Tony Pang
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Hitos
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - James Wei Tatt Toh
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Johnston
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Gary Morgan
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | - Mingjuan Zeng
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Patrick McElduff
- Health Policy Analysis, Sydney, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
2
|
Richardson AJ, Cox MR, Shakeshaft AJ, Hodge B, Morgan G, Pang T, Zeng M, Scanlon K, Austin R, Dawadi A, Burgess C, Rawstron E, Dalton S, Leveque J. Quality improvement in surgery: introduction of the American College of Surgeons National Surgical Quality Improvement Program into New South Wales. ANZ J Surg 2019; 89:471-475. [DOI: 10.1111/ans.15117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Arthur J. Richardson
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Michael R. Cox
- The University of Sydney Sydney New South Wales Australia
- Department of SurgeryNepean Hospital Sydney New South Wales Australia
| | | | - Bruce Hodge
- Department of SurgeryPort Macquarie Hospital Port Macquarie New South Wales Australia
| | - Gary Morgan
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
| | - Tony Pang
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Mingjuan Zeng
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
| | - Kate Scanlon
- Department of SurgeryNepean Hospital Sydney New South Wales Australia
| | - Robyn Austin
- Department of SurgeryPort Macquarie Hospital Port Macquarie New South Wales Australia
| | - Ashma Dawadi
- Department of SurgeryCoffs Harbour Hospital Coffs Harbour New South Wales Australia
| | - Crystal Burgess
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Ellen Rawstron
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Sarah Dalton
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Jean‐Frederic Leveque
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| |
Collapse
|
3
|
Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients. Surg Res Pract 2018; 2018:4321986. [PMID: 30420971 PMCID: PMC6215543 DOI: 10.1155/2018/4321986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P < 0.001), older age (P < 0.001), and higher comorbidity score (P < 0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P < 0.001), heart failure (P = 0.01), peripheral vascular disease (P < 0.001), female sex (P = 0.02), open repair (P < 0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.
Collapse
|
4
|
Affiliation(s)
- Tyler S Wahl
- Department of Surgery, University of Alabama at Birmingham, 1722 7th Avenue South, Kracke Building 217, Birmingham, AL 35249, USA
| | - Mary T Hawn
- Surgery, Stanford University, Alway Building M121, 300 Pasteur Drive, MC 5115, Stanford, CA 94305, USA.
| |
Collapse
|
5
|
Wu D, Price MD, Amarasekara HS, Green SY, Woodside SJ, Tullos A, Zhang Q, Coselli JS, LeMaire SA. Unplanned Readmissions After Open Thoracoabdominal Aortic Aneurysm Repair. Ann Thorac Surg 2018; 105:228-234. [DOI: 10.1016/j.athoracsur.2017.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/21/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
|
6
|
Smith AB, Basch E. Role of Patient-Reported Outcomes in Postsurgical Monitoring in Oncology. J Oncol Pract 2017; 13:535-538. [PMID: 28682667 DOI: 10.1200/jop.2017.023838] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angela B Smith
- University of North Carolina at Chapel Hill and Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Ethan Basch
- University of North Carolina at Chapel Hill and Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| |
Collapse
|
7
|
Affiliation(s)
- Tyler S Wahl
- Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, Kracke Building 417, Birmingham, AL 35249, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University, Alway Building M121, 300 Pasteur Drive, MC 5115, Stanford, CA 94305-2200, USA.
| |
Collapse
|
8
|
Celio AC, Kasten KR, Burruss MB, Pories WJ, Spaniolas K. Surgeon case volume and readmissions after laparoscopic Roux-en-Y gastric bypass: more is less. Surg Endosc 2016; 31:1402-1406. [DOI: 10.1007/s00464-016-5128-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
|
9
|
Affiliation(s)
- Erin G Brown
- Department of General Surgery, UC Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Richard J Bold
- Division of Surgical Oncology, UC Davis Cancer Center, 4501 X Street, Sacramento, CA 95817, USA.
| |
Collapse
|
10
|
Shah SP, Xu T, Hooker CM, Hulbert A, Battafarano RJ, Brock MV, Mungo B, Molena D, Yang SC. Why are patients being readmitted after surgery for esophageal cancer? J Thorac Cardiovasc Surg 2015; 149:1384-9; discussion 1389-91. [PMID: 25983251 DOI: 10.1016/j.jtcvs.2015.01.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/19/2014] [Accepted: 01/24/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Readmission after surgery is an unwanted adverse event that is costly to the healthcare system. We sought to evaluate factors associated with increased risk of readmission and to characterize the nature of these readmissions in patients who have esophageal cancer. METHODS A retrospective cohort study was performed in 306 patients with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by esophagectomy at Johns Hopkins Hospital between 1993 and 2011. Logistic regression was used to identify factors associated with 30-day readmission. Readmissions were defined as inpatient admissions to our institution within 30 days of discharge. RESULTS The median age at surgery was 61 years; the median postoperative length of stay was 9 days; and 48% of patients had ≥1 postoperative complication (POC). The 30-day readmission rate was 13.7% (42 of 306). In univariate analysis, length of stay and having ≥1 POC were significantly associated with readmission. In multivariate analysis, having ≥1 POC was significantly associated with a >2-fold increase in risk for 30-day readmission (odds ratio 2.35, with 95% confidence interval [1.08-5.09], P = .031) when controlling for age at diagnosis and length of stay. Of the 42 patients who were readmitted, 67% experienced POCs after surgery; 50% of patients who experienced POCs were readmitted for reasons related to their postoperative complication. The most common reasons for readmission were pulmonary issues (29%), anastomotic complications (20%), gastrointestinal concerns (17%), and venous thromboembolism (14%). CONCLUSIONS Complications not adequately managed before discharge may lead to readmission. Quality improvement efforts surrounding venous thromboembolism prophylaxis, and discharging patients nothing-by-mouth, may be warranted.
Collapse
Affiliation(s)
- Sneha P Shah
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Tim Xu
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Craig M Hooker
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Alicia Hulbert
- Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Richard J Battafarano
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Malcolm V Brock
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md; Division of Cancer Biology, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Benedetto Mungo
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Daniela Molena
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md.
| |
Collapse
|
11
|
Huang J. Perioperative Surgical Outcomes 100 (PSO 100). Am J Med Qual 2014; 29:364-5. [PMID: 25030533 DOI: 10.1177/1062860614520952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
12
|
Clarke CN, Sussman JJ, Abbott DE, Ahmad SA. Factors affecting readmission after pancreaticoduodenectomy. Adv Surg 2013; 47:99-110. [PMID: 24298846 DOI: 10.1016/j.yasu.2013.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PD continues to be associated with a high rate of failed discharges, despite significant improvements in techniques and postoperative care at high-volume centers. Even in the best hands, 1 in 5 patients undergoing PD can be expected to require readmission in the early postoperative period. Efforts to minimize readmissions must be aimed at identifying high-risk patients, addressing patient expectations, establishing patient care plans, and using outpatient resources to address anticipated problems and complications.
Collapse
Affiliation(s)
- Callisia N Clarke
- Pancreatic Disease Center, Department of Surgery, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH 45219, USA
| | | | | | | |
Collapse
|