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Assessing the association between adherence to process-based quality indicators and surgical outcomes
S60
Surgical Forum Abstracts
J Am Coll Surg
and pulmonary (31.8% vs 21.1%, p<0.01) sentinel complications when compared to younger patients. At the hospital level, high morality centers failed to rescue elderly patients more frequently than low mortality centers after infectious (odds ratio [OR] 2.5; 95%CI 1.4-4.2) and pulmonary (OR 2.1; 95%CI 1.4-3.3) sentinel complications. Failure to rescue rates following cardiovascular, renal, or surgical sentinel complications did not differ significantly across patient ages or tertiles of hospital mortality. CONCLUSIONS: Hospitals fail to rescue elderly patients at higher rates than younger patients after infectious and pulmonary complications. Efforts to recognize and manage these specific sentinel complications have the potential to improve emergency surgical care of the elderly in Michigan.
Age deciles contribute to risk stratification of short-term pancreatectomy morbidity and mortality Nadia M Obeid, MD, Ilan S Rubinfeld, MD, MBA, FACS, David S Kwon, MD, Nathan H Schmoekel, DO, Ryan Kather, Vic Velanovich, MD, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Patients undergoing complex pancreatectomy often experience serious morbidity and mortality. Previous studies suggest that older age is a risk factor for such complications. We sought to elucidate the risks of complex pancreatectomy with increasing age decile. METHODS: Utilizing the National Surgical Quality Improvement Program (NSQIP) participant use files from 2005-2011, patients in the 4th-8th age deciles undergoing complex pancreatectomy were identified by CPT code. NSQIP variables most consistent with Clavien class IV and V complications were identified for each age decile. Logistic regression was performed to acuity adjust the data using ASA and a modified frailty index. RESULTS: 15,311 complex pancreatectomy cases were identified. As age increased from the 4th to 8th decile, the incidence of Clavien IV complications increased from 6.1% to 12.9% (p<0.001), and mortality increased from 0.8% to 4.3% (p<0.001). Similarly, with each progressive age decile, there was an increase in the rate of postoperative pneumonia (4.1% to 6.6%, p¼0.004) and reintubation (2.9% to 7.4%, p<0.001). Significant predictors of mortality by logistic regression included ASA score (OR 2.19, p<0.001) and age decile (OR 1.33, p<0.001). Variables found to be predictive of Clavien IV complications were ASA score (OR 1.72, p<0.001), age decile (OR 1.15, p<0.001) and frailty index (OR 6.02, p<0.001). CONCLUSIONS: Increasing age decile represents predictor of significant adverse events in complex patients. There is an incremental risk of 15% complications and 33% for mortality with each decile.
an independent pancreatectomy for Clavien IV increase in age
The differential effects of surgical harm in elderly populations does the adage, “They tolerate the operation, but not the complications” hold true? Peter D Adams, MD, Ilan S Rubinfeld, MD, MBA, FACS, Ryan Kather, Jennifer Ritz, RN, Roberta Mooney, RN, H Mathilda Horst, MD, Anthony J Falvo, DO, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Elderly patients are thought to tolerate surgical complications poorly due to low physiologic reserve. The purpose of the study was to establish the rates of surgical harm in elderly populations and evaluate the differential effects of surgical harm in patients over 80 years old. METHODS: Three years of data from a harm campaign at a tertiary referral center were used to identify inpatient surgeries performed on patients older than 50. The rates of harm, death, cost, and length of stay were analyzed using SPSS 21 (IBM,NY). RESULTS: There were a total of 22,710 patients identified; 12.5% were >80 years old. There was an overall harm rate of 22.2% and mortality rate of 2.3%. Age>80 was associated with greater length of stay (LOS) (8.03 vs 7.32 days) and higher rates of harm (26.4% vs 21.6%) but ICU days were equal (1.55). Harmed patients over age 80 had increased mortality, but less cost, ICU days and LOS vs those ages 50-80. Linear regression predicting hospital cost showed associated increases with harm ($15,000), death ($15,700), emergency surgery ($3,900), and male gender ($1,700) and decrease with age>80 (-$3,000), and African Americans (-$2,000) . All tests reported here were significant at p<0.001. Mortality Harm increase Mean variable Additional Additional (%) (%) cost increase LOS (days) ICU days
Age 51-80 21.6 Age >80 26.4
6.4 8.3
$15,681 $8,509
11.03 7.54
4.2 2.76
CONCLUSIONS: Advanced age is associated with more hospital harm in surgical patients and harm events are associated with higher mortality rates, but less added cost, and less additional days in the ICU and the hospital. Goals of care and aggressiveness of intervention are not modeled here, and may explain cost avoidance in the elderly. Assessing the association between adherence to process-based quality indicators and surgical outcomes Fadi Hamadani, BSc(Hons), MD, Simon Bergman, MD, MS, FRCSC, FACS, Melina Deban, BS, Vanessa Martelli, BS, Christina Holcroft, ScD, Nadia Sourial, MS, Michele Monette, MS, Helena Zakrzewski, BSc(Hons), Shannon Fraser, MD, MSc, FRCSC, FACS McGill University Montreal, Quebec, Canada INTRODUCTION: The formal development of process-based quality indicators (QIs) by the ACOVE-3 Project and the
Vol. 217, No. 3S, September 2013
American College of Surgeons has evidenced the increasing emphasis on process measurement as a more effective means of quality of care assessment. The purpose of this study was to provide a novel measure of surgical quality of care and to test its association with postoperative complications. METHODS: This is a non-concurrent cohort study of 273 adult patients who underwent elective major abdominal surgery at a single institution. Adherence to ten perioperative QIs was determined (table) and used to calculate a quality score (# of QIs passed/# of QIs eligible). The main outcome was number of 30-day postoperative complications as defined by NSQIP. Poisson regression was used to test for an association between the quality score and complications.
Surgical Forum Abstracts
S61
RESULTS: Mean age and Charlson Comorbidity Index were 64.1 15.3 years and 3.4 3.3, respectively. The mean quality score was 67% 14%. 15.4% of patients developed at least one complication. Controlling for age and gender, Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (IRR 0.98, p¼0.04). Conversely, greater Charlson Comorbidity Index (IRR¼1.10, p¼0.004) and wound class (IRR¼1.81, p¼0.003) were associated with more complications. CONCLUSIONS: This study provides a novel approach to assessing the quality of surgical care. Increased adherence to a broad group of process-based QIs may lead to fewer complications.
Surgical Forum Abstracts
J Am Coll Surg
and pulmonary (31.8% vs 21.1%, p<0.01) sentinel complications when compared to younger patients. At the hospital level, high morality centers failed to rescue elderly patients more frequently than low mortality centers after infectious (odds ratio [OR] 2.5; 95%CI 1.4-4.2) and pulmonary (OR 2.1; 95%CI 1.4-3.3) sentinel complications. Failure to rescue rates following cardiovascular, renal, or surgical sentinel complications did not differ significantly across patient ages or tertiles of hospital mortality. CONCLUSIONS: Hospitals fail to rescue elderly patients at higher rates than younger patients after infectious and pulmonary complications. Efforts to recognize and manage these specific sentinel complications have the potential to improve emergency surgical care of the elderly in Michigan.
Age deciles contribute to risk stratification of short-term pancreatectomy morbidity and mortality Nadia M Obeid, MD, Ilan S Rubinfeld, MD, MBA, FACS, David S Kwon, MD, Nathan H Schmoekel, DO, Ryan Kather, Vic Velanovich, MD, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Patients undergoing complex pancreatectomy often experience serious morbidity and mortality. Previous studies suggest that older age is a risk factor for such complications. We sought to elucidate the risks of complex pancreatectomy with increasing age decile. METHODS: Utilizing the National Surgical Quality Improvement Program (NSQIP) participant use files from 2005-2011, patients in the 4th-8th age deciles undergoing complex pancreatectomy were identified by CPT code. NSQIP variables most consistent with Clavien class IV and V complications were identified for each age decile. Logistic regression was performed to acuity adjust the data using ASA and a modified frailty index. RESULTS: 15,311 complex pancreatectomy cases were identified. As age increased from the 4th to 8th decile, the incidence of Clavien IV complications increased from 6.1% to 12.9% (p<0.001), and mortality increased from 0.8% to 4.3% (p<0.001). Similarly, with each progressive age decile, there was an increase in the rate of postoperative pneumonia (4.1% to 6.6%, p¼0.004) and reintubation (2.9% to 7.4%, p<0.001). Significant predictors of mortality by logistic regression included ASA score (OR 2.19, p<0.001) and age decile (OR 1.33, p<0.001). Variables found to be predictive of Clavien IV complications were ASA score (OR 1.72, p<0.001), age decile (OR 1.15, p<0.001) and frailty index (OR 6.02, p<0.001). CONCLUSIONS: Increasing age decile represents predictor of significant adverse events in complex patients. There is an incremental risk of 15% complications and 33% for mortality with each decile.
an independent pancreatectomy for Clavien IV increase in age
The differential effects of surgical harm in elderly populations does the adage, “They tolerate the operation, but not the complications” hold true? Peter D Adams, MD, Ilan S Rubinfeld, MD, MBA, FACS, Ryan Kather, Jennifer Ritz, RN, Roberta Mooney, RN, H Mathilda Horst, MD, Anthony J Falvo, DO, FACS Henry Ford Hospital, Detroit, MI INTRODUCTION: Elderly patients are thought to tolerate surgical complications poorly due to low physiologic reserve. The purpose of the study was to establish the rates of surgical harm in elderly populations and evaluate the differential effects of surgical harm in patients over 80 years old. METHODS: Three years of data from a harm campaign at a tertiary referral center were used to identify inpatient surgeries performed on patients older than 50. The rates of harm, death, cost, and length of stay were analyzed using SPSS 21 (IBM,NY). RESULTS: There were a total of 22,710 patients identified; 12.5% were >80 years old. There was an overall harm rate of 22.2% and mortality rate of 2.3%. Age>80 was associated with greater length of stay (LOS) (8.03 vs 7.32 days) and higher rates of harm (26.4% vs 21.6%) but ICU days were equal (1.55). Harmed patients over age 80 had increased mortality, but less cost, ICU days and LOS vs those ages 50-80. Linear regression predicting hospital cost showed associated increases with harm ($15,000), death ($15,700), emergency surgery ($3,900), and male gender ($1,700) and decrease with age>80 (-$3,000), and African Americans (-$2,000) . All tests reported here were significant at p<0.001. Mortality Harm increase Mean variable Additional Additional (%) (%) cost increase LOS (days) ICU days
Age 51-80 21.6 Age >80 26.4
6.4 8.3
$15,681 $8,509
11.03 7.54
4.2 2.76
CONCLUSIONS: Advanced age is associated with more hospital harm in surgical patients and harm events are associated with higher mortality rates, but less added cost, and less additional days in the ICU and the hospital. Goals of care and aggressiveness of intervention are not modeled here, and may explain cost avoidance in the elderly. Assessing the association between adherence to process-based quality indicators and surgical outcomes Fadi Hamadani, BSc(Hons), MD, Simon Bergman, MD, MS, FRCSC, FACS, Melina Deban, BS, Vanessa Martelli, BS, Christina Holcroft, ScD, Nadia Sourial, MS, Michele Monette, MS, Helena Zakrzewski, BSc(Hons), Shannon Fraser, MD, MSc, FRCSC, FACS McGill University Montreal, Quebec, Canada INTRODUCTION: The formal development of process-based quality indicators (QIs) by the ACOVE-3 Project and the
Vol. 217, No. 3S, September 2013
American College of Surgeons has evidenced the increasing emphasis on process measurement as a more effective means of quality of care assessment. The purpose of this study was to provide a novel measure of surgical quality of care and to test its association with postoperative complications. METHODS: This is a non-concurrent cohort study of 273 adult patients who underwent elective major abdominal surgery at a single institution. Adherence to ten perioperative QIs was determined (table) and used to calculate a quality score (# of QIs passed/# of QIs eligible). The main outcome was number of 30-day postoperative complications as defined by NSQIP. Poisson regression was used to test for an association between the quality score and complications.
Surgical Forum Abstracts
S61
RESULTS: Mean age and Charlson Comorbidity Index were 64.1 15.3 years and 3.4 3.3, respectively. The mean quality score was 67% 14%. 15.4% of patients developed at least one complication. Controlling for age and gender, Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (IRR 0.98, p¼0.04). Conversely, greater Charlson Comorbidity Index (IRR¼1.10, p¼0.004) and wound class (IRR¼1.81, p¼0.003) were associated with more complications. CONCLUSIONS: This study provides a novel approach to assessing the quality of surgical care. Increased adherence to a broad group of process-based QIs may lead to fewer complications.