Ensuring safe surgical care across resource settings via surgical outcomes data &amp; quality improvement initiatives

Eyob, Belain; Boeck, Marissa A.; Oen, Patrick Fa Si; Cawich, Shamir O; Kluger, Michael D.

doi:10.1016/j.ijsu.2019.07.036

Cited by 15 publications

(12 citation statements)

References 26 publications

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“…Of these, 40 to 50 million were performed in the USA [ 3 , 4 ] and 20 million in Europe [ 5 ]. Estimates of early postoperative mortality rate are 1–4% depending upon country and institution, with the lowest in developed countries and highest in low-income countries [ [6] , [7] , [8] , [9] , [10] ]. These percentages translate to an average global mortality rate of nearly 8 million deaths per year, which is ∼50% lower than cardiovascular disease, and on par with cancer and total injuries [ 11 ] ( Table 1 ).…”

Section: A Global Healthcare Crisis and Growingmentioning

confidence: 99%

Trauma of major surgery: A global problem that is not going away

Dobson

2020

International Journal of Surgery

123

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Globally, a staggering 310 million major surgeries are performed each year; around 40 to 50 million in USA and 20 million in Europe. It is estimated that 1–4% of these patients will die, up to 15% will have serious postoperative morbidity, and 5–15% will be readmitted within 30 days. An annual global mortality of around 8 million patients places major surgery comparable with the leading causes of death from cardiovascular disease and stroke, cancer and injury. If surgical complications were classified as a pandemic, like HIV/AIDS or coronavirus (COVID-19), developed countries would work together and devise an immediate action plan and allocate resources to address it. Seeking to reduce preventable deaths and post-surgical complications would save billions of dollars in healthcare costs. Part of the global problem resides in differences in institutional practice patterns in high- and low-income countries, and part from a lack of effective perioperative drug therapies to protect the patient from surgical stress. We briefly review the history of surgical stress and provide a path forward from a systems-based approach. Key to progress is recognizing that the anesthetized brain is still physiologically ‘awake’ and responsive to the sterile stressors of surgery. New intravenous drug therapies are urgently required after anesthesia and before the first incision to prevent the brain from switching to sympathetic overdrive and activating secondary injury progression such as hyperinflammation, coagulopathy, immune activation and metabolic dysfunction. A systems-based approach targeting central nervous system-mitochondrial coupling may help drive research to improve outcomes following major surgery in civilian and military medicine.

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Section: A Global Healthcare Crisis and Growingmentioning

confidence: 99%

Trauma of major surgery: A global problem that is not going away

Dobson

2020

International Journal of Surgery

123

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“…For example, a simple surgical checklist is a low-cost and effective intervention that has shown demonstrable decreases in clinical errors and mortality. As Internet and mobile phone connectivity continues to grow globally, the development of opensource electronic medical record programs and patient outreach via web-based phone applications or SMS messaging provide opportunities to harness technology to facilitate data collection, communication, and patient engagement [11].…”

Section: Looking To the Futurementioning

confidence: 99%

The Importance of Quality Assurance and Quality Improvement in Low- and Middle-Income Settings

Bhat

McCammon

2021

Curr Bladder Dysfunct Rep

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Purpose of Review This review will discuss the importance of quality improvement in low-and middle-income settings as well as several potential barriers to these measures. Recent Findings There is substantial potential for growth in the field of quality improvement in low-resource settings. The extent of quality improvement (QI) research in low-resource settings is limited but expanding. Summary Patient harm that is attributable to the costs of poor quality is a significant factor in all practice settings but is arguably of greater impact in limited-resource settings. Due to the recognized human, physical, and technological resource limitations in low-and middle-income countries, the delivery of quality healthcare can be variable in many settings, with discrepancies in evidence-based, evidence-informed, and customary care processes. Disparities in training and development of workforce providers exist in addition to limited availability of funding for QI research. Governmental, health ministry, and health system support is also variable. Attention to all of these areas is ultimately necessary to implement affordable and realistic quality improvement initiatives, education, training, and patient safety strategies that can mitigate harms, improve and establish more reliable outcomes, and develop a culture of safety to grow more sustainable and effective workforces and systems.

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“…Additional examples of how these can provide information to improve quality of care are emerging in the HNC arena [8,12,13]. In low resource settings similar initiatives may be difficult to implement but ideas on how to proceed in less developed settings have been published [14].…”

Section: Quality Indicators and Registriesmentioning

confidence: 99%

Value and Quality of Care in Head and Neck Oncology

et al. 2020

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Purpose of Review The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an ongoing process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. Recent Findings This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Summary Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value. Keywords Head and neck. Cancer. Quality of care. Indicators. Value-based health care This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com). This article is part of the Topical Collection on Head and Neck Cancers.

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Ensuring safe surgical care across resource settings via surgical outcomes data & quality improvement initiatives

Cited by 15 publications

References 26 publications

Trauma of major surgery: A global problem that is not going away

Trauma of major surgery: A global problem that is not going away

The Importance of Quality Assurance and Quality Improvement in Low- and Middle-Income Settings

Value and Quality of Care in Head and Neck Oncology

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