Jason B Liu1, Julia R Berian2, Yaoming Liu3, Mark E Cohen3, Clifford Y Ko4, Bruce L Hall5. 1. American College of Surgeons, Chicago, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL. Electronic address: jliu@facs.org. 2. American College of Surgeons, Chicago, IL; Department of Surgery, University of Chicago Medicine, Chicago, IL. 3. American College of Surgeons, Chicago, IL. 4. American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA. 5. American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St Louis, St Louis, MO; Center for Health Policy and the Olin Business School, Washington University in St Louis, St Louis, MO; Saint Louis Veterans Affairs Medical Center, St Louis, MO; BJC Healthcare, St Louis, MO.
Abstract
BACKGROUND: Quality improvement efforts have generally focused on hospital benchmarking, and processes and outcomes shared among all operations. However, quality improvement could be inconsistent across different types of operations. The objective of this study was to identify operations needing additional concerted quality improvement efforts by examining their outcomes trends. STUDY DESIGN: Ten procedures (colectomy, esophagectomy, hepatectomy, hysterectomy, pancreatectomy, proctectomy, total hip arthroplasty, total knee arthroplasty, thyroidectomy, and ventral hernia repair) commonly accrued into the American College of Surgeons NSQIP between 2008 and 2015 were included. Trends in risk-adjusted, standardized, smoothed rates were constructed for each procedure across 6 outcomes (mortality, pneumonia, renal failure, surgical site infection, unplanned intubation, and urinary tract infection [UTI]). RESULTS: Of 1,255,575 operations analyzed, the overall unadjusted rate for mortality across all 10 procedures was 1.08%, for pneumonia 1.44%, for renal failure 0.67%, for surgical site infection 5.28%, for unplanned intubation 1.11%, and for UTI 1.86%. Hepatectomy demonstrated the greatest improvement across outcomes (4 of 6 outcomes; 362 adverse events avoided out of 10,000 procedures), and UTI demonstrated the greatest improvement across procedures (8 of 10 procedures; 989 adverse events avoided out of 10,000). For pancreatectomy, rates of mortality, unplanned intubation, and UTI improved, but surgical site infection rates were detected to have significantly increased (p < 0.05). CONCLUSIONS: Hepatectomy was detected to have improved across the greatest number of outcomes, and UTI rates improved significantly across the greatest number of procedures. Surgical site infection rates after pancreatectomy, however, were detected to have increased, identifying an urgent need for additional concerted quality improvement efforts.
BACKGROUND: Quality improvement efforts have generally focused on hospital benchmarking, and processes and outcomes shared among all operations. However, quality improvement could be inconsistent across different types of operations. The objective of this study was to identify operations needing additional concerted quality improvement efforts by examining their outcomes trends. STUDY DESIGN: Ten procedures (colectomy, esophagectomy, hepatectomy, hysterectomy, pancreatectomy, proctectomy, total hip arthroplasty, total knee arthroplasty, thyroidectomy, and ventral hernia repair) commonly accrued into the American College of Surgeons NSQIP between 2008 and 2015 were included. Trends in risk-adjusted, standardized, smoothed rates were constructed for each procedure across 6 outcomes (mortality, pneumonia, renal failure, surgical site infection, unplanned intubation, and urinary tract infection [UTI]). RESULTS: Of 1,255,575 operations analyzed, the overall unadjusted rate for mortality across all 10 procedures was 1.08%, for pneumonia 1.44%, for renal failure 0.67%, for surgical site infection 5.28%, for unplanned intubation 1.11%, and for UTI 1.86%. Hepatectomy demonstrated the greatest improvement across outcomes (4 of 6 outcomes; 362 adverse events avoided out of 10,000 procedures), and UTI demonstrated the greatest improvement across procedures (8 of 10 procedures; 989 adverse events avoided out of 10,000). For pancreatectomy, rates of mortality, unplanned intubation, and UTI improved, but surgical site infection rates were detected to have significantly increased (p < 0.05). CONCLUSIONS: Hepatectomy was detected to have improved across the greatest number of outcomes, and UTI rates improved significantly across the greatest number of procedures. Surgical site infection rates after pancreatectomy, however, were detected to have increased, identifying an urgent need for additional concerted quality improvement efforts.
Authors: Jason B Liu; Darryl Schuitevoerder; Charles C Vining; Yaniv Berger; Kiran K Turaga; Oliver S Eng Journal: Ann Surg Oncol Date: 2020-07-29 Impact factor: 5.344
Authors: Patrick J Sweigert; Emanuel Eguia; Marshall S Baker; Christina M Link; J Madison Hyer; Anghela Z Paredes; Diamantis I Tsilimigras; Syed Husain; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2020-08-10 Impact factor: 3.452
Authors: Blake N Shultz; Anoop R Galivanche; Taylor D Ottesen; Patawut Bovonratwet; Jonathan N Grauer Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2019-10-02
Authors: Usha Gurunathan; Ivan L Rapchuk; Marilla Dickfos; Peter Larsen; Andrew Forbes; Catherine Martin; Kate Leslie; Paul S Myles Journal: JAMA Netw Open Date: 2019-11-01