Effect of Postdischarge Morbidity and Mortality on Comparisons of Hospital Surgical Quality

Bilimoria, Karl Y.; Cohen, Mark E.; Ingraham, Angela M.; Bentrem, David J.; Richards, Karen; Hall, Bruce L.; Ko, Clifford Y.

doi:10.1097/sla.0b013e3181e4846e

Cited by 116 publications

(84 citation statements)

References 29 publications

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“…22 There are also data from medical as well as other surgical specialties-some of which have been extracted from NSQIP-in which investigators found higher mortality rates in July. 2,3,5,6,18 Although our results do not agree with those of studies focusing on other specialties, our results are consistent with the findings of most other studies that have sought to determine whether a July Effect exists in the practice of neurosurgery. 4,14,15,20 These findings notwithstanding, in our clinical experience we have observed that the July transition period is fraught with clinical challenges.…”

Section: Discussionsupporting

confidence: 79%

“…The lack of data on outcomes after the patient leaves the hospital represents a significant drawback of the NIS database, because more than 30% of adverse events occur within the first 30 days after discharge. 3 There is a need, therefore, to investigate the possible existence of a July Effect by assessing a large number of outcomes among a broad range of neurosurgical patients, including outcomes after discharge from the hospital. In this study we examined a large patient database for evidence of a July Effect on 30-day outcomes among all adult neurosurgery patients.…”

mentioning

confidence: 99%

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Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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obJective Each July, 4th-year medical students become 1st-year resident physicians and have much greater responsibility in making management decisions. In addition, incumbent residents and fellows advance to their next postgraduate year and face greater challenges. It has been suggested that among patients who have resident physicians as members of their neurosurgical team, this transition may be associated with increased rates of morbidity and mortality, a phenomenon known as the "July Effect." In this study, the authors compared morbidity and mortality rates between the initial and later months of the academic year to determine whether there is truly a July Effect that has an impact on this patient population. methods The authors compared 30-day postoperative outcomes of neurosurgery performed by surgical teams that included resident physicians in training during the first academic quarter (Q1, July through September) with outcomes of neurosurgery performed with resident participation during the final academic quarter (Q4, April through June), using 2006-2012 data from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Regression analyses were performed on outcome data that included mortality, surgical complications, and medical complications, which were graded as mild or severe. To determine whether a July Effect was present in subgroups, secondary analyses were performed to analyze the association of outcomes with each major neurosurgical subspecialty, the postgraduate year of the operating resident, and the academic quarter during which the surgery was performed. To control for possible seasonal trends in certain diseases, the authors compared patient outcomes at academic medical centers to those at community-based hospitals, where procedures were not performed by residents. In addition, the efficiency of academic centers was compared to that of community centers in terms of operative duration and total length of hospital stay. results Overall, there were no statistically significant differences in mortality, morbidity, or efficiency between the earlier and later quarters of the academic year, a finding that also held true among neurosurgical subspecialties and among postgraduate levels of training. There was, however, a slight increase in intraoperative transfusions associated with the transitional period in July (6.41% of procedures in Q4 compared to 7.99% in Q1 of the prior calendar year; p = 0.0005), which primarily occurred in cases involving junior (2nd- to 4th-year) residents. In addition, there was an increased rate of reoperation (1.73% in Q4 to 2.19% in Q1; p < 0.0001) observed mainly among senior (5th- to 7th-year) residents in the early academic months and not paralleled in our community cohort. coNclusioNs There is minimal evidence for a significant July Effect in adult neurosurgery. Our results suggest that, overall, the current resident training system provides enough guidance and support during this challenging transit...

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Section: Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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“…Inclusion of post operative discharge events considerably affects hospital quality ranking and the outlier status designation. Quality improvement programme and research that do not consider post discharge outcome may offer incomplete information to hospitals, payers, providers and patients [4] SSI in associated with a mortality rate of 3% an 75% of SSI associated deaths are directly attributable to the SSI [1] .…”

Section: Discussionmentioning

confidence: 99%

Surgical Emergency- A View of a Developing Institute

Thoudam¹

2017

jmscr

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“…We used scrambled social security numbers to link those hospitalizations eligible for post-discharge PSIs to inpatient and outpatient encounters that occurred within the 30-day post-discharge window. While 30 days is a commonly accepted timeframe for examining post-discharge effects, 5,7 we also examined how many PSI events occurred within 1-14 days of discharge to determine whether the majority of AEs occurred shortly after discharge.…”

Section: Identification Of Post-discharge Psi Eventsmentioning

confidence: 99%

“…[1][2][3][4] Additionally, hospital performance measures limited to AE detection during the index hospitalization may misidentify high and low performing hospitals. 5 These studies highlight the need to examine post-discharge data in order to provide a more complete picture of hospital quality and safety performance.…”

Section: Introductionmentioning

confidence: 99%

Using AHRQ Patient Safety Indicators to Detect Postdischarge Adverse Events in the Veterans Health Administration

et al. 2013

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Effect of Postdischarge Morbidity and Mortality on Comparisons of Hospital Surgical Quality

Cited by 116 publications

References 29 publications

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

Surgical Emergency- A View of a Developing Institute

Using AHRQ Patient Safety Indicators to Detect Postdischarge Adverse Events in the Veterans Health Administration

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