What Are the Real Rates of Postoperative Complications: Elucidating Inconsistencies Between Administrative and Clinical Data Sources

Koch, Colleen G.; Li, Liang; Hixson, Eric D.; Tang, Anne; Phillips, Shannon; Henderson, J. Michael

doi:10.1016/j.jamcollsurg.2011.12.037

Cited by 122 publications

(72 citation statements)

References 16 publications

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“…23,24 Misclassification may be a greater source of error in the current setting than in other analyses that have used the NIS. When ACHD patients undergo noncardiac operations, noncardiac surgeons and other inpatient providers (e.g., hospitalists) may not be accurate or precise in their identification of the patient's congenital cardiac lesion.…”

Section: Discussionmentioning

confidence: 94%

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

et al. 2013

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Background: An increasing number of patients with congenital heart disease are surviving to adulthood. Consensus guidelines and expert opinion suggest that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Methods: By using the Nationwide Inpatient Sample database (years 2002 through 2009), the authors compared patients with adult congenital heart disease (ACHD) who underwent noncardiac surgery with a non-ACHD comparison cohort matched on age, sex, race, year, elective or urgent or emergency procedure, van Walraven comborbidity score, and primary procedure code. Mortality and morbidity were compared between the two cohorts. Results: A study cohort consisting of 10,004 ACHD patients was compared with a matched comparison cohort of 37,581 patients. Inpatient mortality was greater in the ACHD cohort (407 of 10,004 [4.1%] vs. 1,355 of 37,581 [3.6%]; unadjusted odds ratio, 1.13; P = 0.031; adjusted odds ratio, 1.29; P < 0.001). The composite endpoint of perioperative morbidity was also more commonly observed in the ACHD cohort (2,145 of 10.004 [21.4%] vs. 6,003 of 37,581 [16.0%]; odds ratio, 1.44; P < 0.001). ACHD patients comprised an increasing proportion of all noncardiac surgical admissions over the study period (P value for trend is <0.001), and noncardiac surgery represented an increasing proportion of all ACHD admissions (P value for trend is <0.001). Conclusions: Compared with a matched control cohort, ACHD patients undergoing noncardiac surgery experienced increased perioperative morbidity and mortality. Within the limitations of a retrospective analysis of a large administrative dataset, this finding demonstrates that this is a vulnerable population and suggests that better efforts are needed to understand and improve the perioperative care they receive.

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Section: Discussionmentioning

confidence: 94%

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

et al. 2013

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“…10 This program has incorporated a wide range of surgical specialties and pediatric-specific comorbidities, procedures, and outcomes. In contrast to claims databases that rely on billing or administrative codes with potentially inconsistent clinical meaning, [11][12][13] the NSQIPPediatric utilizes trained personnel to prospectively collect comprehensive clinical data from the medical record. After establishing feasibility, 8,9 the NSQIP-Pediatric rapidly expanded to include more than 40 hospitals.…”

Section: Discussionmentioning

confidence: 99%

Risk-Adjusted Hospital Outcomes for Children’s Surgery

Saito¹,

Chen

Hall

et al. 2013

Pediatrics

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BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children’s surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. METHODS: Participating institutions included children’s units within general hospitals and free-standing children’s hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. RESULTS: In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. CONCLUSIONS: The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children’s surgery performance indicator. Programmatic improvements have resulted in actionable data.

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“…There are also the biases endemic to the use of such databases 44 . The 30-days readmission rate, following facial fracture, considering all causes, has been estimated to be close to 2% in 2009.…”

Section: Accepted Manuscriptmentioning

confidence: 99%