Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery

Peter Pronovost, Elizabeth Garrett, Todd Dorman, Mollie Jenckes, Thomas H. Webb, Michael Breslow, Brian Rosenfeld, Eric B Bass

Research output: Contribution to journalArticle

Abstract

Background. The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. Patients/methods. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments. Results. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. Conclusions. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.

Original languageEnglish (US)
Pages (from-to)249-256
Number of pages8
JournalLangenbeck's Archives of Surgery
Volume386
Issue number4
DOIs
StatePublished - 2001

Fingerprint

Quality of Health Care
Odds Ratio
Confidence Intervals
Hospital Mortality
Hospital Charges
Heart Arrest
Acute Kidney Injury
Hospital Departments
Marketing
Reoperation
Comorbidity
Sepsis
Myocardial Infarction
Demography
Hemorrhage
Costs and Cost Analysis
Population

Keywords

  • Aortic surgery
  • Complications
  • Outcome
  • Quality
  • Variation

ASJC Scopus subject areas

  • Surgery

Cite this

Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery. / Pronovost, Peter; Garrett, Elizabeth; Dorman, Todd; Jenckes, Mollie; Webb, Thomas H.; Breslow, Michael; Rosenfeld, Brian; Bass, Eric B.

In: Langenbeck's Archives of Surgery, Vol. 386, No. 4, 2001, p. 249-256.

Research output: Contribution to journalArticle

Pronovost, Peter ; Garrett, Elizabeth ; Dorman, Todd ; Jenckes, Mollie ; Webb, Thomas H. ; Breslow, Michael ; Rosenfeld, Brian ; Bass, Eric B. / Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery. In: Langenbeck's Archives of Surgery. 2001 ; Vol. 386, No. 4. pp. 249-256.
@article{f0b87d64b43245dab19ac0e640164848,
title = "Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery",
abstract = "Background. The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. Patients/methods. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments. Results. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95{\%} confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47{\%} for cardiac arrest and 27{\%} for acute renal failure. Conclusions. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.",
keywords = "Aortic surgery, Complications, Outcome, Quality, Variation",
author = "Peter Pronovost and Elizabeth Garrett and Todd Dorman and Mollie Jenckes and Webb, {Thomas H.} and Michael Breslow and Brian Rosenfeld and Bass, {Eric B}",
year = "2001",
doi = "10.1007/s004230100216",
language = "English (US)",
volume = "386",
pages = "249--256",
journal = "Langenbeck's Archives of Surgery",
issn = "1435-2443",
publisher = "Springer Verlag",
number = "4",

}

TY - JOUR

T1 - Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery

AU - Pronovost, Peter

AU - Garrett, Elizabeth

AU - Dorman, Todd

AU - Jenckes, Mollie

AU - Webb, Thomas H.

AU - Breslow, Michael

AU - Rosenfeld, Brian

AU - Bass, Eric B

PY - 2001

Y1 - 2001

N2 - Background. The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. Patients/methods. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments. Results. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. Conclusions. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.

AB - Background. The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. Patients/methods. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments. Results. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. Conclusions. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.

KW - Aortic surgery

KW - Complications

KW - Outcome

KW - Quality

KW - Variation

UR - http://www.scopus.com/inward/record.url?scp=0034944512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034944512&partnerID=8YFLogxK

U2 - 10.1007/s004230100216

DO - 10.1007/s004230100216

M3 - Article

VL - 386

SP - 249

EP - 256

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

SN - 1435-2443

IS - 4

ER -