Improving surgical outcomes through adoption of evidence-based process measures: Intervention specific or associated with overall hospital quality?

Benjamin S. Brooke, Robert A. Meguid, Martin A. Makary, Bruce A. Perler, Peter J. Pronovost, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: The Leapfrog Group aims to improve surgical outcomes through promoting hospital adoption of procedure-specific process measures, although it is unclear whether compliance reflects a hospital's overall quality. The purpose of this study was to evaluate whether implementation of Leapfrog's standard for routine β-blockade was associated with reductions in mortality after open abdominal aortic aneurysm (AAA) repair alone versus other high-risk operations. Methods: Using a 2:1 matched case-control study design, hospitals that had not adopted the β-blockade standard (n = 72) were compared with hospitals that had implemented this Leapfrog standard (n = 36). Leapfrog survey data were linked to patient outcomes in the California OSHPD database from 2000 to 2005. Random-effects Poisson regression models were used to evaluate in-hospital mortality over time for patients undergoing AAA repair versus esophagectomy, hepatectomy, pancreatectomy, colectomy, gastrectomy, and pulmonary lobectomy. Results: A total of 6,199 AAA repairs, 2,780 esophagectomies, 2,544 hepatectomies, 2,909 pancreatectomies, 57,795 colectomies, 6,267 gastrectomies, and 10,210 lobectomies were analyzed. AAA-associated mortality significantly declined in hospitals that adopted the β-blocker standard (relative risk [RR]: 0.49; 95% confidence interval [CI]: 0.24-0.97; P < .05). Implementation of this Leapfrog standard had no effect on reducing adjusted mortality rates for other high-risk operations, including esophagectomy (RR: 0.70; 95% CI: 0.25-1.89), hepatectomy (RR: 1.16; 95% CI: 0.32-4.29), pancreatectomy (RR: 0.76; 95% CI: 0.28-2.02), colectomy (RR: 1.12; 95% CI: 0.86-1.44), gastrectomy (RR: 1.17; 95% CI: 0.57-2.43), and lobectomy (RR: 0.98; 95% CI: 0.46-2.08) (all P > .05). Conclusion: Compliance with peri-operative β-blockade resulted in a significant reduction in mortality after open AAA repair over time, but it had no crossover effect on mortality associated with other high-risk operations in the same hospital. These data suggest that improvements in outcomes resulting from the adoption of evidence-based process measures are procedure specific and do not necessarily reflect overall hospital quality.

Original languageEnglish (US)
Pages (from-to)481-490
Number of pages10
JournalSurgery
Volume147
Issue number4
DOIs
StatePublished - Apr 1 2010

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ASJC Scopus subject areas

  • Surgery

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