Rebecca Sorber1, Katherine A Giuliano2, Caitlin W Hicks3, James H Black2. 1. Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, Md. Electronic address: rsorber1@jhmi.edu. 2. Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, Md. 3. Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, Md; Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins Hospital, Baltimore, Md.
Abstract
OBJECTIVE: National rankings of hospitals rely on outcomes-based evaluation to assess the performance of surgical programs, particularly those performing high-risk elective surgical procedures such as open aortic repair. Various classification systems exist for tracking outcomes, but increasingly the International Classification of Diseases, Tenth Revision-based Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) are used as a publicly reported comparison measure of hospital quality performance. We sought to critically evaluate the accuracy of the existing vehicles to assess open aortic repair outcomes in an established program. METHODS: This is a case-control study of patients who underwent open abdominal aortic aneurysm repair at the Johns Hopkins Medical Institutions from 2004 to 2018. Patients' characteristics and outcomes were collected as part of a prospectively maintained retrospective database. For each case, hemorrhagic, cardiac, respiratory, renal, wound, and thromboembolic complications were identified with the unique definitions used for open abdominal aortic aneurysm repair by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, the Society for Vascular Surgery Vascular Quality Initiative (VQI) database, and the Agency for Healthcare Research and Quality PSI initiative. RESULTS: Of the 154 patients included in the study, 79 (51.0%) were identified as having a complication as defined by the VQI, 46 (29.7%) according to the NSQIP, and 15 (9.7%) according to the PSI system (P < .001). Patients most likely to incur a complication in the PSI system were those with a pararenal or more extensive aneurysm, with baseline congestive heart failure, requiring a supramesenteric clamp (all P < .01), or with an aneurysm >6.5 cm in diameter (P = .02). The NSQIP and VQI systems both identified more postoperative hemorrhagic, respiratory, renal, and wound complications than the PSI system did (P < .05). The VQI system identified the most renal complications (52; P < .001); factors unique to incurring a complication in the VQI include use of a suprarenal clamp and performance of an aortorenal bypass procedure as part of the repair (P < .01). Particularly weak correlation was noted between the PSI system and the VQI with respect to renal outcomes (ρ = 0.163). CONCLUSIONS: The PSI system identified fewer important complications than either of the clinically focused databases, with the VQI capturing the most postoperative events, mostly because of its stringent definition of renal injury. We conclude that the PSI system should not form the basis of grading hospital performance in comparing clinically relevant complications of open aortic surgery programs.
OBJECTIVE: National rankings of hospitals rely on outcomes-based evaluation to assess the performance of surgical programs, particularly those performing high-risk elective surgical procedures such as open aortic repair. Various classification systems exist for tracking outcomes, but increasingly the International Classification of Diseases, Tenth Revision-based Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) are used as a publicly reported comparison measure of hospital quality performance. We sought to critically evaluate the accuracy of the existing vehicles to assess open aortic repair outcomes in an established program. METHODS: This is a case-control study of patients who underwent open abdominal aortic aneurysm repair at the Johns Hopkins Medical Institutions from 2004 to 2018. Patients' characteristics and outcomes were collected as part of a prospectively maintained retrospective database. For each case, hemorrhagic, cardiac, respiratory, renal, wound, and thromboembolic complications were identified with the unique definitions used for open abdominal aortic aneurysm repair by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, the Society for Vascular Surgery Vascular Quality Initiative (VQI) database, and the Agency for Healthcare Research and Quality PSI initiative. RESULTS: Of the 154 patients included in the study, 79 (51.0%) were identified as having a complication as defined by the VQI, 46 (29.7%) according to the NSQIP, and 15 (9.7%) according to the PSI system (P < .001). Patients most likely to incur a complication in the PSI system were those with a pararenal or more extensive aneurysm, with baseline congestive heart failure, requiring a supramesenteric clamp (all P < .01), or with an aneurysm >6.5 cm in diameter (P = .02). The NSQIP and VQI systems both identified more postoperative hemorrhagic, respiratory, renal, and wound complications than the PSI system did (P < .05). The VQI system identified the most renal complications (52; P < .001); factors unique to incurring a complication in the VQI include use of a suprarenal clamp and performance of an aortorenal bypass procedure as part of the repair (P < .01). Particularly weak correlation was noted between the PSI system and the VQI with respect to renal outcomes (ρ = 0.163). CONCLUSIONS: The PSI system identified fewer important complications than either of the clinically focused databases, with the VQI capturing the most postoperative events, mostly because of its stringent definition of renal injury. We conclude that the PSI system should not form the basis of grading hospital performance in comparing clinically relevant complications of open aortic surgery programs.
Authors: Thomas F X O'Donnell; Laura T Boitano; Sarah E Deery; Robert T Lancaster; Jeffrey J Siracuse; Marc L Schermerhorn; Salvatore T Scali; Virendra I Patel Journal: Ann Surg Date: 2020-01 Impact factor: 12.969
Authors: Michelle C Nguyen; Susan D Moffatt-Bruce; Anne Van Buren; Iahn Gonsenhauser; Daniel S Eiferman Journal: Surgery Date: 2017-12-21 Impact factor: 3.982
Authors: Liesa Zabrocki; Frank Marquardt; Klaus Albrecht; Andreas Kribben; Stefan Herget-Rosenthal Journal: Ann Vasc Surg Date: 2017-09-22 Impact factor: 1.466
Authors: Salvatore T Scali; Kristina A Giles; Paul Kubilis; Adam W Beck; Cristina J Crippen; Steven J Hughes; Thomas S Huber; Gilbert R Upchurch; David H Stone Journal: J Vasc Surg Date: 2019-09-09 Impact factor: 4.268
Authors: Daniel I McIsaac; Gavin M Hamilton; Karim Abdulla; Luke T Lavallée; Husien Moloo; Chris Pysyk; Jocelyn Tufts; William A Ghali; Alan J Forster Journal: BMJ Qual Saf Date: 2019-08-22 Impact factor: 7.035
Authors: Azra Bihorac; Meghan Brennan; Tezcan Ozrazgat-Baslanti; Shahab Bozorgmehri; Philip A Efron; Frederick A Moore; Mark S Segal; Charles E Hobson Journal: Crit Care Med Date: 2013-11 Impact factor: 7.598
Authors: Bradford D Winters; Aamir Bharmal; Renee F Wilson; Allen Zhang; Lilly Engineer; Deidre Defoe; Eric B Bass; Sydney Dy; Peter J Pronovost Journal: Med Care Date: 2016-12 Impact factor: 2.983
Authors: Lily E Johnston; William P Robinson; Margaret C Tracci; John A Kern; Kenneth J Cherry; Irving L Kron; Gilbert R Upchurch Journal: J Vasc Surg Date: 2016-06-30 Impact factor: 4.268