Adverse outcomes in surgery: redefinition of postoperative complications
ABSTRACT We propose that excess risk-adjusted, postoperative length of stay (poLOS) is a valid indicator of an adverse outcome.
Hospital administrative claims data for elective colon resection, coronary bypass graft surgery, and total hip replacement were used from the 100 largest-volume hospitals in the Health Care Cost and Utilization Project for 2005. Risk-adjusted poLOS linear models were designed and outliers were determined using control charts. Costs of hospital care were examined by the presence of coded complications (CCs) and/or being a poLOS outlier.
Patterns of CCs and risk-adjusted poLOS outliers were significantly different (P < .0001, chi-square test). For all procedures, costs of care were similar with or without CCs if the patients were not poLOS outliers. For patients who were poLOS outliers, costs were significantly different (Tukey-Kramer test) independent of whether CCs were present or not.
Adverse surgical outcomes are better defined by risk-adjusted poLOS and cost criteria rather than coded or surveillance observations.
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ABSTRACT: Identification of postsurgical complications is the first step towards improving patient safety and health care quality as well as reducing heath care cost. Existing NLP-based approaches for retrieving postsurgical complications are based on search strategies. Here, we conduct a sublanguage analysis study using free text reports available for a cohort of patients with postsurgical complications identified manually to compare the keywords identified by subject matter experts with words/phrases automatically identified by sublanguage analysis. The results suggest that search-based approaches may miss some cases and the sublanguage analysis results can be used as a base to develop an information extraction system or support search-based NLP approaches by augmenting search queries.04/2014; 2014:77-82.
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ABSTRACT: Morbid events after pediatric congenital cardiac surgery are increasingly used for better outcome measurement and quality comparisons. This study was undertaken to evaluate the relationship between a hospital's risk-adjusted prevalence of prolonged postoperative length of stay (PLOS) and its risk-adjusted mortality rate to investigate whether PLOS can serve as an appropriate quality measure for pediatric congenital cardiac surgery. Risk-adjusted prevalence of prolonged PLOS for 12 programs in New York State was estimated using data from 4,776 operations in the New York State pediatric Cardiac Surgery Reporting System (2006-2009). We used logistic regression analysis to adjust for case mix and patient risk factors. The hospital-level correlation between risk-adjusted prolonged PLOS and risk-adjusted mortality rates was examined using Spearman correlation coefficient analysis. Risk-adjusted prevalence of prolonged PLOS ranged from 7.48% to 36.52% for pediatric cardiac programs in New York State during the study period. The Spearman correlation test showed a strong positive relationship between a hospital's risk-adjusted prolonged PLOS and mortality rate (r = 0.83; p = 0.0008). Prolonged PLOS can be used in lieu of risk-adjusted mortality rates when it is not practical to use mortality rates owing to low case volume or decreasing mortality rates of some procedures.The Annals of thoracic surgery 01/2014; 97(6). DOI:10.1016/j.athoracsur.2013.11.008 · 3.65 Impact Factor
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ABSTRACT: Background. Little information is available about postdischarge adverse events after laparoscopic cholecystectomy. Methods. Inpatient and 90-day postdischarge adverse events were identified for Medicare patients discharged in 2009-2010 after undergoing elective laparoscopic cholecystectomy on day 0, 1, or 2 of hospitalization at facilities that performed 20 or more laparoscopic cholecystectomies during the study period. A predictive length of stay (LOS) linear regression model was derived and used to identify patients with prolonged LOS (prLOS) whose risk-adjusted LOS exceeded a 3 sigma upper limit on a moving average control chart. Rates of inpatient and 90-day fatal and nonfatal adverse events and interrelationships among different outcomes and alternative outcome measures were explored. Results. Of 89,639 study cases, 0.7% died during their index hospitalization, and 1.3% died within 90 days of discharge. Of live discharges, 8.0% had prLOS, and 42.1% had coded complication. In the 90 days after discharge, 9,416 (10.6%) were readmitted. Patients who were prLOS outliers were more likely to die or be readmitted than nonoutliers (P < .0001; chi(2)). Conclusion. More than 18% of Medicare patients undergoing presumably low-risk elective inpatient laparoscopic cholecystectomy died, had a severe inpatient complication, or were readmitted within 90 days of discharge.Surgery 10/2014; 156(4):931-8. DOI:10.1016/j.surg.2014.06.023 · 3.11 Impact Factor