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A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals.

Abstract：

BACKGROUND:Regional surgical quality improvement consortiums are becoming more common. Herein we have reported the effectiveness of a statewide consortium focusing on open vascular operative procedures. METHODS:The statewide Michigan Surgical Quality Consortium was established in 2005 with 16 hospitals that report cases of vascular open operative intervention, in a sampling manner consistent with the private sector National Surgical Quality Improvement Program. Data are abstracted by onsite trained nurses using defined and validated pre-, peri-, and postoperative variables with 30-day follow-up. Outpatient and emergent cases were excluded. We compared outcomes over the course of the consortium (era I, April 2005-March 2007; era II, April 2007-March 2008) via univariate and multivariate techniques. RESULTS:Era I (n = 2,453) and era II (n = 3,409) cases were similar in age (mean, 68 years), gender (61% male), relative value units (mean, 21), and distribution of Current Procedural Terminology codes. Duration of stay and operative time decreased by 15% and 11%, respectively, when comparing era I with era II (P < .001). Mortality at 30 days was not different between eras I and II (2.7% vs 2.5%; P = NS), but morbidity was decreased (15.8% vs 13.8%; P = .02). Specific decreases were noted in sepsis and pulmonary, but not cardiac or renal, complications. When evaluating both eras, modifiable variables (able to be altered by the surgeon) for morbidity included increased length of operation (odds ratio [OR], 1.004; 95% confidence interval [CI], 1.003-1.005; P < .0001), hypertension (OR, 1.46; 95% CI, 1.03-2.1; P = .03), and blood transfusion (OR, 2.8; 95% CI, 2.04-3.88; P < .0001). However, anemic patients (11%; hematocrit <30) who were transfused were less likely to suffer morbidity (OR, 56; 95% CI, 0.47-0.67; P < .0001) than those transfused who were not anemic. The absolute 2% reduction in complications led to a $172 cost savings for the payers per patient in era II compared with era I. CONCLUSION:A statewide quality-of-care consortium with timely feedback of data was associated with decreased morbidity over a relatively short follow-up period in vascular patients. Focusing on best processes in real-world practice, such as appropriate transfusion and length of operation, may further improve vascular surgical outcomes.

journal_name

Surgery

journal_title

Surgery

authors

Henke PK,Kubus J,Englesbe MJ,Harbaugh C,Campbell DA

doi

10.1016/j.surg.2010.07.009

subject

Has Abstract

pub_date

2010-10-01 00:00:00

pages

883-89; discussion 889-92

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(10)00371-5

journal_volume

148

pub_type

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A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals.