OBJECTIVE: To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed. DESIGN: Epidemiological analysis. INTERVENTIONS: Derivation and assessment of predictive equations for postoperative infectious events and decubitus ulcers using Healthcare Cost and Utilization Project Nationwide Inpatient Sample administrative claims data for patients hospitalized between 2002 and 2005. MAIN OUTCOME MEASURES: C statistics for each predictive equation with and without hospital dummy variables. RESULTS: Predictive equations for 6 of 8 complications had C statistics greater than 0.65 without hospital variables, while 2 had C statistics of less than 0.55. All equations had C statistics greater than 0.75 when hospital dummy variables were included. CONCLUSIONS: Patient characteristics and type of operative procedure are important predictors of complications of surgical care evaluated in this study, undermining the rationale for their current classification as "never events." Variations in risk-adjusted complication rates among hospitals support the influence of quality of care on their occurrence. Development and use of warranties to cover costs associated with caring for the unavoidable components of potentially avoidable complications is proposed as a means of rewarding high-quality providers without creating unrealistic expectations or perverse financial incentives.
OBJECTIVE: To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed. DESIGN: Epidemiological analysis. INTERVENTIONS: Derivation and assessment of predictive equations for postoperative infectious events and decubitus ulcers using Healthcare Cost and Utilization Project Nationwide Inpatient Sample administrative claims data for patients hospitalized between 2002 and 2005. MAIN OUTCOME MEASURES: C statistics for each predictive equation with and without hospital dummy variables. RESULTS: Predictive equations for 6 of 8 complications had C statistics greater than 0.65 without hospital variables, while 2 had C statistics of less than 0.55. All equations had C statistics greater than 0.75 when hospital dummy variables were included. CONCLUSIONS:Patient characteristics and type of operative procedure are important predictors of complications of surgical care evaluated in this study, undermining the rationale for their current classification as "never events." Variations in risk-adjusted complication rates among hospitals support the influence of quality of care on their occurrence. Development and use of warranties to cover costs associated with caring for the unavoidable components of potentially avoidable complications is proposed as a means of rewarding high-quality providers without creating unrealistic expectations or perverse financial incentives.
Authors: R S Guerra; T F Amaral; A S Sousa; F Pichel; M T Restivo; S Ferreira; I Fonseca Journal: Eur J Clin Nutr Date: 2014-11-05 Impact factor: 4.016
Authors: Rachel M Owen; Sebastian D Perez; Nathan Lytle; Ankit Patel; S S Davis; Edward Lin; John F Sweeney Journal: Surg Endosc Date: 2013-04-13 Impact factor: 4.584
Authors: James Studnicki; Bola F Ekezue; Maka Tsulukidze; Peggy Honoré; Ramal Moonesinghe; John Fisher Journal: Am J Med Qual Date: 2013-03-24 Impact factor: 1.852
Authors: Eliza W Beal; Ezra Lyon; Joe Kearney; Lai Wei; Cecilia G Ethun; Sylvester M Black; Mary Dillhoff; Ahmed Salem; Sharon M Weber; Thuy B Tran; George Poultsides; Rivfka Shenoy; Ioannis Hatzaras; Bradley Krasnick; Ryan C Fields; Stefan Buttner; Charles R Scoggins; Robert C G Martin; Chelsea A Isom; Kamron Idrees; Harveshp D Mogal; Perry Shen; Shishir K Maithel; Timothy M Pawlik; Carl R Schmidt Journal: HPB (Oxford) Date: 2017-09-07 Impact factor: 3.647