Association between quality of care and complications after abdominal surgery
| Autor: | Helena Zakrzewski, Vanessa Martelli, Melina Deban, Fadi Hamadani, Shannon A. Fraser, Christina Holcroft, Nadia Sourial, Michèle Monette, Debby Teasdale, Simon Bergman |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Quality management Pilot Projects Rate ratio Cohort Studies symbols.namesake Postoperative Complications Abdomen medicine Humans Poisson regression Aged Quality Indicators Health Care Quality of Health Care Retrospective Studies business.industry Incidence (epidemiology) Quebec Retrospective cohort study Middle Aged Surgical Procedures Operative Quality Score Emergency medicine Physical therapy symbols Female Surgery business Abdominal surgery Cohort study |
| Zdroj: | Surgery. 156:632-639 |
| ISSN: | 0039-6060 |
| Popis: | Background Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. Methods This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009–2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression. Results The mean overall patient quality score was 67.2 ± 14.4% (range, 25–100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI. Conclusion Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives. |
| Databáze: | OpenAIRE |
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