Association of Hospital Participation in a Surgical Outcomes Monitoring Program With Inpatient Complications and Mortality
Association of Hospital Participation in a Surgical Outcomes Monitoring Program With Inpatient Complications and Mortality
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DOI：
10.1001/jama.2015.90
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发表时间：
2015-02-03
影响因子：
120.7
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
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作者：
Etzioni, David A.;Wasif, Nabil;Habermann, Elizabeth B.
重要性：分析和报告手术并发症发生率的项目日益成为质量改进工作的重点。在美国，目前用于结果监测的最全面的工具是美国外科医师学会（ACS）国家手术质量改进计划（NSQIP）。目的：比较参加NSQIP和未参加NSQIP医院患者的手术结果。设计、环境和参与者：2009年1月至2013年7月来自大学健康系统联盟的数据用于确定代表美国广泛的选择性一般/血管手术的选择性住院。医院参与NSQIP的数据是通过查阅美国医学会出版的半年度报告获得的。在研究期间停止或开始参与NSQIP的任何医院的住院情况在该医院的状态发生变化之日后被排除在外。采用差异中的差异方法对医院参与NSQIP与术后转归率随时间变化之间的关系进行建模。暴露医院参与NSQIP。主要结局和测量：择期普通/血管手术住院期间任何并发症、严重并发症和死亡率的风险调整率。结果纳入113所不同专科医院的345 357例住院患者；172 882例（50.1%）住院在NSQIP医院。住院患者以女性为主（61.5%），平均年龄55.7岁。在分析的住院病例中，最常见的手术类型是疝气修复（15.7%）、减肥（10.5%）、乳房切除术（9.7%）和胆囊切除术（9.0%）。在考虑了患者风险、手术类型、潜在的医院表现和时间趋势后，差异中差异模型显示，NSQIP医院和非NSQIP医院在并发症的可能性（校正优势比1.00;95% CI 0.97-1.03）、严重并发症（校正优势比0.98;95% CI 0.94-1.03）或死亡率（校正优势比1.04;95% CI 0.94-1.14）方面随时间没有统计学上的显著差异。结论和相关性在美国学术医院接受选择性全身/血管手术的大队列患者中，未发现以医院为基础参与NSQIP与术后预后的改善之间存在关联。这些发现表明，手术结果报告系统并没有提供一个明确的机制来提高质量。
IMPORTANCE Programs that analyze and report rates of surgical complications are an increasing focus of quality improvement efforts. The most comprehensive tool currently used for outcomes monitoring in the United States is the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP).OBJECTIVE To compare surgical outcomes experienced by patients treated at hospitals that did vs did not participate in the NSQIP.DESIGN, SETTING, AND PARTICIPANTS Data from the University HealthSystem Consortium from January 2009 to July 2013 were used to identify elective hospitalizations representing a broad spectrum of elective general/vascular operations in the United States. Data on hospital participation in the NSQIP were obtained through review of semiannual reports published by the ACS. Hospitalizations at any hospital that discontinued or initiated participation in the NSQIP during the study period were excluded after the date on which that hospital's status changed. A difference-in-differences approach was used to model the association between hospital-based participation in NSQIP and changes in rates of postoperative outcomes over time.EXPOSURE Hospital participation in the NSQIP.MAIN OUTCOMES AND MEASURES Risk-adjusted rates of any complications, serious complications, and mortality during a hospitalization for elective general/vascular surgery.RESULTS The cohort included 345 357 hospitalizations occurring in 113 different academic hospitals; 172 882 (50.1%) hospitalizations were in NSQIP hospitals. Hospitalized patients were predominantly female (61.5%), with a mean age of 55.7 years. The types of procedures performed most commonly in the analyzed hospitalizations were hernia repairs (15.7%), bariatric (10.5%), mastectomy (9.7%), and cholecystectomy (9.0%). After accounting for patient risk, procedure type, underlying hospital performance, and temporal trends, the difference-in-differences model demonstrated no statistically significant differences over time between NSQIP and non-NSQIP hospitals in terms of likelihood of complications (adjusted odds ratio, 1.00; 95% CI, 0.97-1.03), serious complications (adjusted odds ratio, 0.98; 95% CI, 0.94-1.03), or mortality (adjusted odds ratio, 1.04; 95% CI, 0.94-1.14).CONCLUSIONS AND RELEVANCE No association was found between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time within a large cohort of patients undergoing elective general/vascular operations at academic hospitals in the United States. These findings suggest that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.