Orthopaedic Surgery Complications at a Tertiary Care Hospital in a Low- and Middle-Income Country: A National Surgical Quality Improvement Project Analysis.

Autor:	Hasan SH; From the Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan (Dr. Hasan, Dr. Ali, Dr. Khan and Dr. Noordin); Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan (Dr. Zafar); Department of Infection Prevention & Hospital Epidemiology, Aga Khan University Hospital, Karachi, Pakistan (Ms. Jivani and Ms. Ziauddin); University of Toronto, Ontario, Canada (Ms. Pidani)., Ali U, Khan J, Pidani AS, Jivani N, Ziauddin A, Zafar H, Noordin S
Jazyk:	angličtina
Zdroj:	Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews [J Am Acad Orthop Surg Glob Res Rev] 2023 Oct 23; Vol. 7 (10). Date of Electronic Publication: 2023 Oct 23 (Print Publication: 2023).
DOI:	10.5435/JAAOSGlobal-D-23-00074
Abstrakt:	Background: Through a comparison of orthopaedic surgical procedures performed at a tertiary care hospital in Pakistan with other participating hospitals of National Surgical Quality Improvement Project (NSQIP), we aim to identify the areas of orthopaedic surgical care at our center that need improvement and also those which are at par with international standards. Methods: The study analyses orthopaedic surgeries at a tertiary care hospital in Pakistan using NSQIP registry to compare complication rates with other American College of Surgeons-NSQIP participant hospitals. Two reviewers collect data in different days every 8 days to reduce bias, and the results are reported in odds ratios using quarterly reports. This study included 584 eligible orthopaedic cases performed in 2021. Yearly institutional reports with odds ratios were also used to identify areas needing improvement and to implement changes to improve orthopaedic surgical outcomes at said institute. Results: The quarterly reports suggest a relatively higher OR for certain indicators such as cardiac events, surgical site infection, mortality, and morbidity throughout. The renal failure rate was very high in the third and fourth quarters with odds ratios of 4.57 and 10.31, respectively. However, the official NSQIP annual institutional report for 2021 identified sepsis, surgical site infections, and cardiac complications as areas 'needing improvement'. It also indicated that the hospital performed exemplarily when it came to venous thromboembolism (VTE). As for the rest of the indicators, the hospital fell in the 'as expected' category of the NSQIP standards. Conclusion: This initial report helps the hospital's orthopaedic department in recognizing areas for improvement and making system-level changes to improve patient outcomes. The implementation of these interventions has yielded favorable outcomes, as evidenced by the findings in the NSQIP yearly report for 2022. Reinforcements and measures are needed to be taken to reduce the adverse events even further and to improve the patient outcomes and quality. Competing Interests: The authors would like to disclose that no external funding was received for this research project. All expenses related to this study were covered by the Department of Surgery, Aga Khan University, and there was no involvement from any third-party organization or individual that may have had a financial interest in the outcomes of this study. As such, there are no conflicts of interest related to funding to declare for any of the authors. (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
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