Association between Surgical Care Improvement Program venous thromboembolism measures and postoperative events
ABSTRACT BACKGROUND: In 2006, the Surgical Care Improvement Program (SCIP) implemented measures to reduce venous thromboembolism (VTE). There are little data on whether these measures reduce VTE rates. This study proposed to examine associations between SCIP-VTE adherence and VTE rates. METHODS: SCIP-VTE adherence for 30,531 surgeries from 2006 to 2009 was linked with VA Surgical Quality Improvement Program data. Patient demographics, comorbidities, and surgical characteristics associated with VTE were summarized. VTE rates were compared by SCIP-VTE adherence. Multivariable logistic regression was used to model VTE by adherence, adjusting for multiple associated factors. RESULTS: Of 30,531 surgeries, 89.9% adhered to SCIP-VTE; 1.4% experienced VTE. Logistic regression identified obesity, smoking, functional status, weight loss, emergent status, age older than 64 years, and surgical time as associated with VTE. SCIP-VTE was not associated with VTE (1.4% vs 1.33%; P = .3), even after adjustment. CONCLUSIONS: This study identified several important risk factors for VTE but found no association with SCIP-VTE adherence.
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ABSTRACT: Background Public reporting of mortality, patient safety indicators (PSI) and hospital acquired conditions (HAC) is the reality of quality measurement. Review of our Department’s data identified opportunities for improvement. We began a surgeon led, 100% review of mortality, PSIs and HACs to improve patient care and surgeon awareness of these metrics. Study Design From 12/2012 through 8/2013 11,899 patients were cared for on 12 surgical services. A surgeon from each service led monthly reviews of all mortality, PSIs or HACs with central reporting of preventability and coding accuracy. We compared the UHC OE mortality ratios (<1 means fewer observed than expected deaths) and UHC relative rankings (lower number is better) before and after implementation. Statistical significance was p<0.05 by Poisson regression. Results Of the 11,899 patients in the study period, there were 235 deaths, 290 PSIs and 26 HACs identified and reviewed. The most common PSIs were postoperative DVT/PTE (75), respiratory failure (61), hemorrhage/hematoma (33) and accidental puncture/laceration (33). Prior to 12/2012, the OE ratio for mortality was consistently >1 and fell and remained <1 during the study period (p<0.05). The OE mortality ratio in the 4th quarter of 2012 was 1.14 and fell to 0.88, .91 and .75 in the first, second and third quarters of calendar year 2013(p<0.05). The overall IQI90 (composite postop mortality rank) rankings increased from 109/118 in the 3rd quarter of 2012 to 47/119 in the third quarter of 2013. Conclusions Surgeon led systematic review of mortality, PSIs and HACs improved our OE ratio and UHC postsurgical relative rankings. Surgeon engagement and ownership is critical for success.Journal of the American College of Surgeons 01/2013; 218(4). DOI:10.1016/j.jamcollsurg.2013.12.023 · 4.45 Impact Factor
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ABSTRACT: BACKGROUND: Postoperative venous thromboembolism (VTE) is increasingly viewed as a quality of care metric, although risk-adjusted incident rates of postoperative VTE and VTE after hospital discharge (VTEDC) are not available. We sought to characterize the predictors of VTE and VTEDC to develop nomograms to estimate individual risk of VTE and VTEDC. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 471,867 patients who underwent inpatient abdominal or thoracic operations between 2005 and 2010. We excluded primary vascular and spine operations. We built logistic regression models using stepwise model selection and constructed nomograms for VTE and VTEDC with statistically significant covariates. RESULTS: The overall, unadjusted, 30-d incidence of VTE and VTEDC was 1.5% and 0.5%, respectively. Annual incidence rates remained unchanged over the study period. On multivariate analysis, age, body mass index, presence of preoperative infection, operation for cancer, procedure type (spleen highest), multivisceral resection, and non-bariatric laparoscopic surgery were significant predictors for VTE and VTEDC. Other significant predictors for VTE, but not VTEDC, included a history of chronic obstructive pulmonary disease, disseminated cancer, and emergent operation. We constructed and validated nomograms by bootstrapping. The concordance indices for VTE and VTEDC were 0.77 and 0.67, respectively. CONCLUSIONS: Substantial variation exists in the incidence of VTE and VTEDC, depending on patient and procedural factors. We constructed nomograms to predict individual risk of 30-d VTE and VTEDC. These may allow more targeted quality improvement interventions to reduce VTE and VTEDC in high-risk general and thoracic surgery patients.Journal of Surgical Research 01/2013; 183(1). DOI:10.1016/j.jss.2012.12.016 · 2.12 Impact Factor
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ABSTRACT: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can prolong survival in peritoneal-based malignancies. These malignancies harbor in visceral and omental adipose tissue, and as a result, obesity may contribute to greater tumor burden. Obesity also is an independent risk factor for perioperative complications following major surgery. No studies to date have investigated the effect of elevated body mass index (BMI) on disease burden and perioperative outcomes in CRS-HIPEC patients. Observational study of consecutive patients taken to the operating suite from 2007 to 2012 for CRS-HIPEC. Data were reviewed retrospectively, and patients for whom complete cytoreduction was not achieved and those with BMI <18.5 were excluded. Various operative data points, including peritoneal cancer index, surgery length, and estimated blood loss, were measured prospectively. Perioperative complications were identified and recorded. Complete data for review was available for 114 patients. Patients were subdivided based on BMI (group A 18.5-24.9, n = 43; group B 25-29.9, n = 49; group C ≥ 30, n = 22). There was no statistically significant difference in tumor burden, operative length, probability of unresectable disease, operative blood loss, or length of stay between groups. Rates of respiratory, gastrointestinal, infectious, renal, and hematologic complications were not statistically different, with the exception of deep vein thrombosis (A = 0, B = 13.5 %, C = 0; p = 0.026). CRS-HIPEC can be safely performed in overweight and obese patients without significant increase in perioperative morbidity. Despite the limitations in physical examination and increase in visceral fat, they do not appear to present later than patients with normal BMI, nor do they have higher tumor burden.Annals of Surgical Oncology 10/2013; 21(5). DOI:10.1245/s10434-013-3280-3 · 3.94 Impact Factor