Youri Q M Poelemeijer1,2, Perla J Marang-van de Mheen3, Michel W J M Wouters4,5, Simon W Nienhuijs6, Ronald S L Liem7,8. 1. Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands. Y.Q.M.Poelemeijer@lumc.nl. 2. Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, ZA, Netherlands. Y.Q.M.Poelemeijer@lumc.nl. 3. Department of Biomedical Data Science, Leiden University Medical Center, Leiden, Netherlands. 4. Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands. 5. Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands. 6. Department of Surgery, Catharina Hospital, Eindhoven, Netherlands. 7. Department of Surgery, Groene Hart Hospital, Gouda, Netherlands. 8. Dutch Obesity Clinic, The Hague, Netherlands.
Abstract
INTRODUCTION: Textbook outcome (TO) studies have previously shown that a composite measure can provide additional information on the overall quality of surgical care. However, these were binominal outcomes which do not give individual hospitals the required information on how to improve their performance. The aim of this study is to create an ordered TO consisting of multiple outcome parameters for bariatric surgery to assess the extent of hospital variation. METHODS: Patients who underwent a primary bariatric procedure in the Netherlands were included for analyses. The outcomes were ordered as mortality, severe postoperative complications, readmission, mild complications and prolonged length of stay (LOS) within 30 days after primary surgery with TO defined as none of these outcomes occurring. Hospitals were identified with a significantly higher or lower observed/expected ratio than expected based on case-mix and the extent of hospital variation was expressed as the median and interquartile range (IQR). RESULTS: From a total of 27,360 patients on average, 88.7% reached TO (range 35.5-96.9%). Two hospitals had less than expected TO due to more prolonged LOS (57.6%) in one hospital and more mild complications in another (17.1%). Hospital variation was much smaller for TO (median OR 0.91 IQR [0.62-1.06]) than for an ordered TO (median POR 0.66 IQR [0.55-0.96]). CONCLUSION: Using the ordered TO for bariatric surgery, more hospital variation was captured thereby enabling individual hospitals to identify which outcomes and specific groups need improvement. This could attribute to the ongoing effort to improve the quality of the outcome of bariatric surgery.
INTRODUCTION: Textbook outcome (TO) studies have previously shown that a composite measure can provide additional information on the overall quality of surgical care. However, these were binominal outcomes which do not give individual hospitals the required information on how to improve their performance. The aim of this study is to create an ordered TO consisting of multiple outcome parameters for bariatric surgery to assess the extent of hospital variation. METHODS: Patients who underwent a primary bariatric procedure in the Netherlands were included for analyses. The outcomes were ordered as mortality, severe postoperative complications, readmission, mild complications and prolonged length of stay (LOS) within 30 days after primary surgery with TO defined as none of these outcomes occurring. Hospitals were identified with a significantly higher or lower observed/expected ratio than expected based on case-mix and the extent of hospital variation was expressed as the median and interquartile range (IQR). RESULTS: From a total of 27,360 patients on average, 88.7% reached TO (range 35.5-96.9%). Two hospitals had less than expected TO due to more prolonged LOS (57.6%) in one hospital and more mild complications in another (17.1%). Hospital variation was much smaller for TO (median OR 0.91 IQR [0.62-1.06]) than for an ordered TO (median POR 0.66 IQR [0.55-0.96]). CONCLUSION: Using the ordered TO for bariatric surgery, more hospital variation was captured thereby enabling individual hospitals to identify which outcomes and specific groups need improvement. This could attribute to the ongoing effort to improve the quality of the outcome of bariatric surgery.
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