Donald E Fry1, Susan M Nedza2, Michael Pine3, Agnes M Reband3, Chun-Jung Huang3, Gregory Pine3. 1. MPA Healthcare Solutions, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico.. Electronic address: dfry@consultmpa.com. 2. MPA Healthcare Solutions, Chicago, Illinois; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 3. MPA Healthcare Solutions, Chicago, Illinois.
Abstract
BACKGROUND: Risk-adjusted outcomes of elective major vascular surgery that is inclusive of inpatient and 90-day post-discharge adverse outcomes together have not been well studied. METHODS: We studied 2012-2014 Medicare inpatients who received open aortic procedures, open peripheral vascular procedures, endovascular aortic procedures, and percutaneous angioplasty procedures of the lower extremity for risk-adjusted adverse outcomes of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day post-discharge associated readmissions after excluding unrelated events. Observed and predicted total adverse outcomes for hospitals meeting minimum risk-volume criteria were assessed and hospital-specific z-scores and risk-adjusted adverse outcomes were calculated to compare performance. RESULTS: The total adverse-outcome rate was 27.8% for open aortic procedures, 31.5% for open peripheral vascular procedures, 19.6% for endovascular aortic procedures, and 36.4% for percutaneous angioplasty procedures. The difference in risk-adjusted adverse-outcome rates between the best- and the poorest-performing deciles were 32.2% for open aortic procedures, 29.5% for open peripheral vascular procedures, 21.5% for endovascular aortic procedures, and 37.1% for percutaneous angioplasty procedures. The 90-day post-discharge deaths and readmissions were the major driver of overall adverse-outcome rates. CONCLUSION: The variability in risk-adjusted outcomes among best- and poorest-performing hospitals is over 20% in all major vascular procedures and indicates that a large opportunity exists for improvement in results.
BACKGROUND: Risk-adjusted outcomes of elective major vascular surgery that is inclusive of inpatient and 90-day post-discharge adverse outcomes together have not been well studied. METHODS: We studied 2012-2014 Medicare inpatients who received open aortic procedures, open peripheral vascular procedures, endovascular aortic procedures, and percutaneous angioplasty procedures of the lower extremity for risk-adjusted adverse outcomes of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day post-discharge associated readmissions after excluding unrelated events. Observed and predicted total adverse outcomes for hospitals meeting minimum risk-volume criteria were assessed and hospital-specific z-scores and risk-adjusted adverse outcomes were calculated to compare performance. RESULTS: The total adverse-outcome rate was 27.8% for open aortic procedures, 31.5% for open peripheral vascular procedures, 19.6% for endovascular aortic procedures, and 36.4% for percutaneous angioplasty procedures. The difference in risk-adjusted adverse-outcome rates between the best- and the poorest-performing deciles were 32.2% for open aortic procedures, 29.5% for open peripheral vascular procedures, 21.5% for endovascular aortic procedures, and 37.1% for percutaneous angioplasty procedures. The 90-day post-discharge deaths and readmissions were the major driver of overall adverse-outcome rates. CONCLUSION: The variability in risk-adjusted outcomes among best- and poorest-performing hospitals is over 20% in all major vascular procedures and indicates that a large opportunity exists for improvement in results.
Authors: Yazan M Duwayri; Francesco A Aiello; Margaret C Tracci; Susan Nedza; Patrick C Ryan; John G Adams; William P Shutze; Ying Wei Lum; Karen Woo Journal: J Vasc Surg Date: 2020-07-08 Impact factor: 4.268