Article

The Patient Safety in Surgery Study: Background, Study Design, and Patient Populations

Harvard University, Cambridge, Massachusetts, United States
Journal of the American College of Surgeons (Impact Factor: 4.45). 07/2007; 204(6):1089-102. DOI: 10.1016/j.jamcollsurg.2007.03.028
Source: PubMed

ABSTRACT The purpose of this article is to describe the background, design, and patient populations of the Patient Safety in Surgery Study, as a preliminary to the articles in this journal that will report the results of the Study.
The Patient Safety in Surgery Study was a prospective cohort study. Trained nurses collected preoperative risk factors, operative variables, and 30-day postoperative mortality and morbidity outcomes in patients undergoing major general and vascular operations at 128 Veterans Affairs (VA) medical centers and 14 selected university medical centers between October 1, 2001 and September 30, 2004. An Internet-based data collection system was used to input data from the different private medical centers. Semiannual feedback of observed to expected mortality and morbidity ratios was provided to the participating medical centers.
During the 3-year study, total accrual in general surgery was 145,618 patients, including 68.5% from the VA and 31.5% from the private sector. Accrual in vascular surgery totaled 39,225 patients, including 77.8% from the VA and 22.2% from the private sector. VA patients were older and included a larger proportion of male patients and African Americans and Hispanics. The VA population included more inguinal, umbilical, and ventral hernia repairs, although the private-sector population included more thyroid and parathyroid, appendectomy, and operations for breast cancer. Preoperative comorbidities were similar in the two populations, but the rates of comorbidities were higher in the VA. American Society of Anesthesiologists classification tended to be higher in the VA.
The National Surgical Quality Improvement Program methodology was successfully implemented in the 14 university medical centers. The data from the study provided the basis for the articles in this issue of the Journal of the American College of Surgeons.

Download full-text

Full-text

Available from: Robert M Mentzer, Sep 04, 2015
0 Followers
 · 
259 Views
 · 
496 Downloads
  • Source
    • "Postoperative transfusion involved bleeding that required at least 1 unit of transfusion. All variables were used as defined in the ACS-NSQIP user guide [10]. IBM SPSS Statistics version 22 was used to perform all statistics in this study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Tibial shaft fractures are often treated by intramedullary nailing (IMN) or plate fixation. Our purpose was to compare the 30-day complication rates between IMN and plate fixation of extra-articular tibial fractures.
    Injury 12/2014; 28(4). DOI:10.1016/j.injury.2014.12.014 · 2.46 Impact Factor
  • Source
    • "They also showed that tachycardia > 100 beats/min may increases the likelihood of cardiac events. The American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) tended to find a correlation between hemodynamic changes and perioperative cardiac events in a 30-day follow up [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia's safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist.
    International Archives of Medicine 04/2014; 7:17. DOI:10.1186/1755-7682-7-17 · 1.08 Impact Factor
  • Source
    • "there remain significant post-operative morbidity, mortality and occasional need for prolonged hospitalisation [1] [2] [3] [4] [5] [6] [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Structured care pathways optimising peri-operative care have been shown to significantly enhance post-operative recovery. We aim to determine if enhanced recovery after surgery (ERAS) principles could provide benefit for paediatric patients undergoing major colorectal resection for inflammatory bowel disease (IBD). Children undergoing elective bowel resection for IBD at a regional paediatric unit using standard methods of peri-operative care were matched to adult cases from an associated tertiary referral university hospital already using an ERAS program. Cases were matched for disease type, gender, operative procedure, and ASA grade. Forty-four children undergoing fifty procedures were identified. Thirty-four were matched to adult cases. Total length of stay in the paediatric group was significantly longer than in the adult group (6 vs. 9days; P=0.001). Paediatric patients were slower to start solid diet (1 vs. 4days; P<0.0001) and were slower to mobilize post-operatively (1 vs. 4days; P<0.0001). No difference was seen in time to restoration of bowel function (2 vs. 3days; P=0.49). Thirty day readmissions and total in-hospital morbidity were not significantly different between the groups. Potentially, application of ERAS in paediatric surgery could accelerate recovery and reduce length of post-operative stay thereby improving quality and efficiency of care.
    Journal of Pediatric Surgery 09/2013; 48(9):1924-30. DOI:10.1016/j.jpedsurg.2013.02.063 · 1.31 Impact Factor
Show more