INTRODUCTION: The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated. METHODS: The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI. RESULTS: In total, 27,376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification. CONCLUSIONS: Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.
INTRODUCTION: The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated. METHODS: The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI. RESULTS: In total, 27,376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification. CONCLUSIONS: Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.
Authors: S F Khuri; J Daley; W Henderson; K Hur; J O Gibbs; G Barbour; J Demakis; G Irvin; J F Stremple; F Grover; G McDonald; E Passaro; P J Fabri; J Spencer; K Hammermeister; J B Aust Journal: J Am Coll Surg Date: 1997-10 Impact factor: 6.113
Authors: J Daley; S F Khuri; W Henderson; K Hur; J O Gibbs; G Barbour; J Demakis; G Irvin; J F Stremple; F Grover; G McDonald; E Passaro; P J Fabri; J Spencer; K Hammermeister; J B Aust; C Oprian Journal: J Am Coll Surg Date: 1997-10 Impact factor: 6.113
Authors: T Okabayashi; I Nishimori; K Yamashita; T Sugimoto; T Yatabe; H Maeda; M Kobayashi; K Hanazaki Journal: J Hosp Infect Date: 2009-07-28 Impact factor: 3.926
Authors: D H Culver; T C Horan; R P Gaynes; W J Martone; W R Jarvis; T G Emori; S N Banerjee; J R Edwards; J S Tolson; T S Henderson Journal: Am J Med Date: 1991-09-16 Impact factor: 4.965
Authors: Ayòtúndé B Fadayomi; Gyulnara G Kasumova; Omidreza Tabatabaie; Susanna W L de Geus; Tara S Kent; Sing Chau Ng; A James Moser; Mark P Callery; Stanley W Ashley; Jennifer F Tseng Journal: HPB (Oxford) Date: 2018-03-09 Impact factor: 3.647
Authors: Jeffrey D Bernstein; David J Bracken; Shira R Abeles; Ryan K Orosco; Philip A Weissbrod Journal: World J Otorhinolaryngol Head Neck Surg Date: 2022-04-18
Authors: Frank W Brennfleck; Lena Linsenmeier; Henrik H G Junger; Katharina M Schmidt; Jens M Werner; Daniel Woehl; Florian Zeman; Ingrid Mutzbauer; James A Hutchinson; Edward K Geissler; Hans J Schlitt; Stefan M Brunner Journal: Trials Date: 2020-11-09 Impact factor: 2.279