Hospital-level variation in secondary complications after surgery

Elliot Wakeam, Joseph A. Hyder, Stuart R. Lipsitz, Mark E. Cohen, Dennis P. Orgill, Michael J. Zinner, Cliff Y. Ko, Bruce L. Hall, Samuel R G Finlayson

Research output: Contribution to journalArticle

Abstract

To assess whether hospital rates of secondary complications could serve as a performance benchmark and examine associations with mortality. Background: Failure to rescue (death after postoperative complication) is a challenging target for quality improvement. Secondary complications (complications after a first or "index" complication) are intermediate outcomes in the rescue process that may provide specific improvement targets and give us insight into how rescue fails. Methods: We used American College of Surgeons' National Surgical Quality Improvement Program data (2008-2012) to define hospital rates of secondary complications after 5 common index complications: pneumonia, surgical site infection (SSI), urinary tract infection, transfusion/bleed events, and acute myocardial infarction (MI). Hospitals were divided into quintiles on the basis of risk-and reliability-adjusted rates of secondary complications, and these rates were compared along with mortality. Results: A total of 524,860 patients were identified undergoing one of the 62 elective, inpatient operations. After index pneumonia, secondary complication rates varied from 57.99% in the highest quintile to 22.93% in the lowest [adjusted odds ratio (OR), 4.64; confidence interval (CI), 3.95-5.45). Wide variation was seen after index SSI (58.98% vs 14.81%; OR, 8.53; CI, 7.41-9.83), urinary tract infection (38.41% vs 8.60%; OR, 7.81; CI, 6.48-9.40), transfusion/bleeding events (27.14% vs 12.88%; OR, 2.54; CI, 2.31-2.81), and acute MI (64.45% vs 23.86%, OR, 6.87; CI, 5.20-9.07). Hospitals in the highest quintile had significantly greater mortality after index pneumonia (10.41% vs 6.20%; OR, 2.17; CI, 1.6-2.94), index MI (18.25% vs 9.65%; OR, 2.67; CI, 1.80-3.94), and index SSI (2.75% vs 0.82%; OR, 3.93; CI, 2.26-6.81). Conclusions: Hospital-level rates of secondary complications (failure to arrest complications) vary widely, are associated with mortality, and may be useful for quality improvement and benchmarking.

Original languageEnglish (US)
Pages (from-to)493-501
Number of pages9
JournalAnnals of Surgery
Volume263
Issue number3
DOIs
StatePublished - 2016
Externally publishedYes

Fingerprint

Odds Ratio
Confidence Intervals
Surgical Wound Infection
Quality Improvement
Benchmarking
Pneumonia
Mortality
Myocardial Infarction
Urinary Tract Infections
Inpatients
Hemorrhage

Keywords

  • Benchmarking
  • failure to rescue
  • performance measurement
  • surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Wakeam, E., Hyder, J. A., Lipsitz, S. R., Cohen, M. E., Orgill, D. P., Zinner, M. J., ... Finlayson, S. R. G. (2016). Hospital-level variation in secondary complications after surgery. Annals of Surgery, 263(3), 493-501. https://doi.org/10.1097/SLA.0000000000001227

Hospital-level variation in secondary complications after surgery. / Wakeam, Elliot; Hyder, Joseph A.; Lipsitz, Stuart R.; Cohen, Mark E.; Orgill, Dennis P.; Zinner, Michael J.; Ko, Cliff Y.; Hall, Bruce L.; Finlayson, Samuel R G.

In: Annals of Surgery, Vol. 263, No. 3, 2016, p. 493-501.

Research output: Contribution to journalArticle

Wakeam, E, Hyder, JA, Lipsitz, SR, Cohen, ME, Orgill, DP, Zinner, MJ, Ko, CY, Hall, BL & Finlayson, SRG 2016, 'Hospital-level variation in secondary complications after surgery', Annals of Surgery, vol. 263, no. 3, pp. 493-501. https://doi.org/10.1097/SLA.0000000000001227
Wakeam E, Hyder JA, Lipsitz SR, Cohen ME, Orgill DP, Zinner MJ et al. Hospital-level variation in secondary complications after surgery. Annals of Surgery. 2016;263(3):493-501. https://doi.org/10.1097/SLA.0000000000001227
Wakeam, Elliot ; Hyder, Joseph A. ; Lipsitz, Stuart R. ; Cohen, Mark E. ; Orgill, Dennis P. ; Zinner, Michael J. ; Ko, Cliff Y. ; Hall, Bruce L. ; Finlayson, Samuel R G. / Hospital-level variation in secondary complications after surgery. In: Annals of Surgery. 2016 ; Vol. 263, No. 3. pp. 493-501.
@article{8f85b4c07d9846bd84243140a857c517,
title = "Hospital-level variation in secondary complications after surgery",
abstract = "To assess whether hospital rates of secondary complications could serve as a performance benchmark and examine associations with mortality. Background: Failure to rescue (death after postoperative complication) is a challenging target for quality improvement. Secondary complications (complications after a first or {"}index{"} complication) are intermediate outcomes in the rescue process that may provide specific improvement targets and give us insight into how rescue fails. Methods: We used American College of Surgeons' National Surgical Quality Improvement Program data (2008-2012) to define hospital rates of secondary complications after 5 common index complications: pneumonia, surgical site infection (SSI), urinary tract infection, transfusion/bleed events, and acute myocardial infarction (MI). Hospitals were divided into quintiles on the basis of risk-and reliability-adjusted rates of secondary complications, and these rates were compared along with mortality. Results: A total of 524,860 patients were identified undergoing one of the 62 elective, inpatient operations. After index pneumonia, secondary complication rates varied from 57.99{\%} in the highest quintile to 22.93{\%} in the lowest [adjusted odds ratio (OR), 4.64; confidence interval (CI), 3.95-5.45). Wide variation was seen after index SSI (58.98{\%} vs 14.81{\%}; OR, 8.53; CI, 7.41-9.83), urinary tract infection (38.41{\%} vs 8.60{\%}; OR, 7.81; CI, 6.48-9.40), transfusion/bleeding events (27.14{\%} vs 12.88{\%}; OR, 2.54; CI, 2.31-2.81), and acute MI (64.45{\%} vs 23.86{\%}, OR, 6.87; CI, 5.20-9.07). Hospitals in the highest quintile had significantly greater mortality after index pneumonia (10.41{\%} vs 6.20{\%}; OR, 2.17; CI, 1.6-2.94), index MI (18.25{\%} vs 9.65{\%}; OR, 2.67; CI, 1.80-3.94), and index SSI (2.75{\%} vs 0.82{\%}; OR, 3.93; CI, 2.26-6.81). Conclusions: Hospital-level rates of secondary complications (failure to arrest complications) vary widely, are associated with mortality, and may be useful for quality improvement and benchmarking.",
keywords = "Benchmarking, failure to rescue, performance measurement, surgery",
author = "Elliot Wakeam and Hyder, {Joseph A.} and Lipsitz, {Stuart R.} and Cohen, {Mark E.} and Orgill, {Dennis P.} and Zinner, {Michael J.} and Ko, {Cliff Y.} and Hall, {Bruce L.} and Finlayson, {Samuel R G}",
year = "2016",
doi = "10.1097/SLA.0000000000001227",
language = "English (US)",
volume = "263",
pages = "493--501",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Hospital-level variation in secondary complications after surgery

AU - Wakeam, Elliot

AU - Hyder, Joseph A.

AU - Lipsitz, Stuart R.

AU - Cohen, Mark E.

AU - Orgill, Dennis P.

AU - Zinner, Michael J.

AU - Ko, Cliff Y.

AU - Hall, Bruce L.

AU - Finlayson, Samuel R G

PY - 2016

Y1 - 2016

N2 - To assess whether hospital rates of secondary complications could serve as a performance benchmark and examine associations with mortality. Background: Failure to rescue (death after postoperative complication) is a challenging target for quality improvement. Secondary complications (complications after a first or "index" complication) are intermediate outcomes in the rescue process that may provide specific improvement targets and give us insight into how rescue fails. Methods: We used American College of Surgeons' National Surgical Quality Improvement Program data (2008-2012) to define hospital rates of secondary complications after 5 common index complications: pneumonia, surgical site infection (SSI), urinary tract infection, transfusion/bleed events, and acute myocardial infarction (MI). Hospitals were divided into quintiles on the basis of risk-and reliability-adjusted rates of secondary complications, and these rates were compared along with mortality. Results: A total of 524,860 patients were identified undergoing one of the 62 elective, inpatient operations. After index pneumonia, secondary complication rates varied from 57.99% in the highest quintile to 22.93% in the lowest [adjusted odds ratio (OR), 4.64; confidence interval (CI), 3.95-5.45). Wide variation was seen after index SSI (58.98% vs 14.81%; OR, 8.53; CI, 7.41-9.83), urinary tract infection (38.41% vs 8.60%; OR, 7.81; CI, 6.48-9.40), transfusion/bleeding events (27.14% vs 12.88%; OR, 2.54; CI, 2.31-2.81), and acute MI (64.45% vs 23.86%, OR, 6.87; CI, 5.20-9.07). Hospitals in the highest quintile had significantly greater mortality after index pneumonia (10.41% vs 6.20%; OR, 2.17; CI, 1.6-2.94), index MI (18.25% vs 9.65%; OR, 2.67; CI, 1.80-3.94), and index SSI (2.75% vs 0.82%; OR, 3.93; CI, 2.26-6.81). Conclusions: Hospital-level rates of secondary complications (failure to arrest complications) vary widely, are associated with mortality, and may be useful for quality improvement and benchmarking.

AB - To assess whether hospital rates of secondary complications could serve as a performance benchmark and examine associations with mortality. Background: Failure to rescue (death after postoperative complication) is a challenging target for quality improvement. Secondary complications (complications after a first or "index" complication) are intermediate outcomes in the rescue process that may provide specific improvement targets and give us insight into how rescue fails. Methods: We used American College of Surgeons' National Surgical Quality Improvement Program data (2008-2012) to define hospital rates of secondary complications after 5 common index complications: pneumonia, surgical site infection (SSI), urinary tract infection, transfusion/bleed events, and acute myocardial infarction (MI). Hospitals were divided into quintiles on the basis of risk-and reliability-adjusted rates of secondary complications, and these rates were compared along with mortality. Results: A total of 524,860 patients were identified undergoing one of the 62 elective, inpatient operations. After index pneumonia, secondary complication rates varied from 57.99% in the highest quintile to 22.93% in the lowest [adjusted odds ratio (OR), 4.64; confidence interval (CI), 3.95-5.45). Wide variation was seen after index SSI (58.98% vs 14.81%; OR, 8.53; CI, 7.41-9.83), urinary tract infection (38.41% vs 8.60%; OR, 7.81; CI, 6.48-9.40), transfusion/bleeding events (27.14% vs 12.88%; OR, 2.54; CI, 2.31-2.81), and acute MI (64.45% vs 23.86%, OR, 6.87; CI, 5.20-9.07). Hospitals in the highest quintile had significantly greater mortality after index pneumonia (10.41% vs 6.20%; OR, 2.17; CI, 1.6-2.94), index MI (18.25% vs 9.65%; OR, 2.67; CI, 1.80-3.94), and index SSI (2.75% vs 0.82%; OR, 3.93; CI, 2.26-6.81). Conclusions: Hospital-level rates of secondary complications (failure to arrest complications) vary widely, are associated with mortality, and may be useful for quality improvement and benchmarking.

KW - Benchmarking

KW - failure to rescue

KW - performance measurement

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=84959311962&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959311962&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001227

DO - 10.1097/SLA.0000000000001227

M3 - Article

C2 - 25876007

AN - SCOPUS:84959311962

VL - 263

SP - 493

EP - 501

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -