TY - JOUR
T1 - Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery
AU - Scally, Christopher P.
AU - Yin, Huiying
AU - Birkmeyer, John D.
AU - Wong, Sandra L.
N1 - Funding Information:
Grant sponsor: National Cancer Institute; Grant number: 5T32CA009672-23; Grant sponsor: National Cancer Institute; Grant number: 2R01 CA098481-05A1; Grant sponsor: Agency for Healthcare Research and Quality; Grant number: K08 HS020937-01. Dr. Birkmeyer is a consultant and has an equity interest in ArborMetrix, Inc., which provides software and analytics for measuring hospital quality and efficiency. The company had no role in the study herein. Dr. Scally is supported by a grant from the National Cancer Institute (5T32CA009672-23). This study was supported by a grant to Dr. Birkmeyer from the National Cancer Institute 2R01 CA098481-05A1. Dr. Wong is supported by the Agency for Healthcare Research and Quality K08 HS020937-01. The views expressed herein do not necessarily represent the views of the United States Government.
Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2015/12/15
Y1 - 2015/12/15
N2 - Background Pancreatic surgery outcomes vary widely. We hypothesize that by comparing high and low mortality hospitals, we may identify differences in patient care impacting safety. Methods We sampled hospitals with very-low and very-high mortality (LMH; HMH) and conducted on-site chart reviews evaluating perioperative care practices for pancreatic operations. Results HMHs had an 11.6% mortality rate; LMHs 1.5%. Patients in HMHs had worse ASA classification (20.9% ASA Class 4/5 vs. 2.0%, P < 0.001) and comorbidity burden (55.3% with ≥1 comorbidity vs. 39.6%, P = 0.037). At HMHs, operations took longer (353.9 min vs. 313.7 min, P = 0.05), had higher blood loss (1,203.7 ml vs. 881.6 ml, P = 0.04), and patients underwent more transfusions (70.2% vs. 41.1%, P < 0.001). There were differences in anesthetic care: less invasive monitoring (76.1% vs. 93.1%, P < 0.001) and epidural pain management (22.5% vs. 62.9%, P < 0.001). Both cohorts had similar rates of VTE prophylaxis and SSI prevention compliance. Conclusion High and low mortality hospitals both have high compliance with common quality measures; however, HMHs performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts.
AB - Background Pancreatic surgery outcomes vary widely. We hypothesize that by comparing high and low mortality hospitals, we may identify differences in patient care impacting safety. Methods We sampled hospitals with very-low and very-high mortality (LMH; HMH) and conducted on-site chart reviews evaluating perioperative care practices for pancreatic operations. Results HMHs had an 11.6% mortality rate; LMHs 1.5%. Patients in HMHs had worse ASA classification (20.9% ASA Class 4/5 vs. 2.0%, P < 0.001) and comorbidity burden (55.3% with ≥1 comorbidity vs. 39.6%, P = 0.037). At HMHs, operations took longer (353.9 min vs. 313.7 min, P = 0.05), had higher blood loss (1,203.7 ml vs. 881.6 ml, P = 0.04), and patients underwent more transfusions (70.2% vs. 41.1%, P < 0.001). There were differences in anesthetic care: less invasive monitoring (76.1% vs. 93.1%, P < 0.001) and epidural pain management (22.5% vs. 62.9%, P < 0.001). Both cohorts had similar rates of VTE prophylaxis and SSI prevention compliance. Conclusion High and low mortality hospitals both have high compliance with common quality measures; however, HMHs performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts.
KW - inpatients/statistics and numerical data
KW - neoplasms/surgery
KW - outcome and process assessment
KW - perioperative care
KW - quality improvement/trends
KW - quality of healthcare
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U2 - 10.1002/jso.24085
DO - 10.1002/jso.24085
M3 - Article
C2 - 26593455
AN - SCOPUS:84955170526
SN - 0022-4790
VL - 112
SP - 866
EP - 871
JO - Journal of surgical oncology
JF - Journal of surgical oncology
IS - 8
ER -