BACKGROUND: Process measures constitute the focal point of surgical quality studies. High levels of compliance with such processes have not correlated with improved outcomes. Wide ranges of reported hospital death rates led us to hypothesize that survival after elective colon resection would be a legitimate outcomes measure for quality of surgical practice. STUDY DESIGN: We studied risk-adjusted hospital mortality rates of 85,260 patients in teaching hospitals as reported to the University HealthSystem Consortium (UHC) January 1, 2005 to March 31, 2011. Data were analyzed by institution and surgeon (deidentified). There were 34,504 patients from the HealthCare Utilization Project (HCUP, 2007-2008), who provided a comparison group for nonteaching hospitals. Surgeons with less than 1 year of reported data were excluded. RESULTS: Elective colon resection mortality rates were densely concentrated around 1.56% for teaching hospitals and at 1.08% for defined surgeons. HCUP data demonstrated a 1.38% nonteaching hospital mortality rate. Neither hospital nor surgeon volume were determinants of mortality, and lower volume entities displayed the widest mortality variations. Among 193 teaching hospitals, there were 6 outliers (4.1%), defined as >2 standard deviations (SDs) above the mean. Similarly, 32 of 681 individual surgeons (4.7%) had a risk-adjusted hospital mortality rate >2SDs above the mean. CONCLUSIONS: Elective colon resection is a safe procedure in both teaching hospitals and nonteaching hospitals, with an impressively homogenous mean mortality rate of 1.56% in teaching hospitals, and 1.38% in nonteaching hospitals. We reject our original hypothesis because the data do not sufficiently discriminate to permit the use of death after elective colon resection as a differentiating quality measure; however, the data do identify individual poor performers. Poor performing institutions/surgeons should seek extramural guidance to improve their outcomes or discontinue performing such operations.
BACKGROUND: Process measures constitute the focal point of surgical quality studies. High levels of compliance with such processes have not correlated with improved outcomes. Wide ranges of reported hospital death rates led us to hypothesize that survival after elective colon resection would be a legitimate outcomes measure for quality of surgical practice. STUDY DESIGN: We studied risk-adjusted hospital mortality rates of 85,260 patients in teaching hospitals as reported to the University HealthSystem Consortium (UHC) January 1, 2005 to March 31, 2011. Data were analyzed by institution and surgeon (deidentified). There were 34,504 patients from the HealthCare Utilization Project (HCUP, 2007-2008), who provided a comparison group for nonteaching hospitals. Surgeons with less than 1 year of reported data were excluded. RESULTS: Elective colon resection mortality rates were densely concentrated around 1.56% for teaching hospitals and at 1.08% for defined surgeons. HCUP data demonstrated a 1.38% nonteaching hospital mortality rate. Neither hospital nor surgeon volume were determinants of mortality, and lower volume entities displayed the widest mortality variations. Among 193 teaching hospitals, there were 6 outliers (4.1%), defined as >2 standard deviations (SDs) above the mean. Similarly, 32 of 681 individual surgeons (4.7%) had a risk-adjusted hospital mortality rate >2SDs above the mean. CONCLUSIONS: Elective colon resection is a safe procedure in both teaching hospitals and nonteaching hospitals, with an impressively homogenous mean mortality rate of 1.56% in teaching hospitals, and 1.38% in nonteaching hospitals. We reject our original hypothesis because the data do not sufficiently discriminate to permit the use of death after elective colon resection as a differentiating quality measure; however, the data do identify individual poor performers. Poor performing institutions/surgeons should seek extramural guidance to improve their outcomes or discontinue performing such operations.
Authors: Perry Shen; Aaron U Blackham; Stacey Lewis; Clancy J Clark; Russell Howerton; Harveshp D Mogal; Rebecca M Dodson; Gregory B Russell; Edward A Levine Journal: J Am Coll Surg Date: 2017-01-11 Impact factor: 6.113
Authors: Rachelle N Damle; Christopher W Macomber; Julie M Flahive; Jennifer S Davids; W Brian Sweeney; Paul R Sturrock; Justin A Maykel; Heena P Santry; Karim Alavi Journal: J Am Coll Surg Date: 2014-03-12 Impact factor: 6.113
Authors: Justin T Brady; Bona Ko; Samuel F Hohmann; Benjamin P Crawshaw; Jennifer A Leinicke; Scott R Steele; Knut M Augestad; Conor P Delaney Journal: Surg Endosc Date: 2017-12-27 Impact factor: 4.584
Authors: P Christensen; K Krogh; B Perrouin-Verbe; D Leder; G Bazzocchi; B Petersen Jakobsen; A V Emmanuel Journal: Tech Coloproctol Date: 2015-11-16 Impact factor: 3.781
Authors: Alberto Posabella; Niccolò Rotigliano; Athanasios Tampakis; Markus von Flüe; Ida Füglistaler Journal: Int J Colorectal Dis Date: 2018-05-17 Impact factor: 2.571
Authors: Thomas Worland; Oliver Cronin; Benjamin Harrison; Linda Alexander; Nik Ding; Alvin Ting; Stephanie Dimopoulos; Racheal Sykes; Sina Alexander Journal: Endosc Int Open Date: 2019-10-22