Journal of the American College of Surgeons
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Multicenter Study
Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system.
Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care. ⋯ We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage.
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Multicenter Study
Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly.
Whether preoperative risk prediction improves with the use of more patient- and procedure-targeted models is unclear. We created a customized preoperative mortality risk prediction score for patients 80 years or older needing an emergency colectomy and compare it with existing, more generic risk assessment methods. ⋯ Our study presents a validated preoperative mortality score for very elderly patients needing an emergency colectomy. The greater discriminating power of this targeted score indicates that preoperative risk assessment may need to be customized to specific procedures and patient circumstances.
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Multicenter Study
How valid is the AHRQ Patient Safety Indicator "postoperative hemorrhage or hematoma"?
Postoperative hemorrhage or hematoma (PHH), an Agency for Healthcare Research and Quality Patient Safety Indicator, uses administrative data to detect cases of potentially preventable postsurgical bleeding requiring a reparative procedure. How accurately it identifies true events is unknown. We therefore determined PHH's positive predictive value. ⋯ PHH's accuracy could be improved by coding enhancements, such as adopting present on admission codes or associating a timing factor with codes dealing with bleeding control. The ability of PHH to identify events representing quality of care problems requires additional evaluation.
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Multicenter Study
Positive predictive value of the AHRQ Patient Safety Indicator "Postoperative Sepsis": implications for practice and policy.
Patient Safety Indicator (PSI) 13, or "Postoperative Sepsis," of the Agency for Healthcare Quality and Research (AHRQ), was recently adopted as part of a composite measure of patient safety by the Centers for Medicare and Medicaid Services (CMS). We sought to examine its positive predictive value (PPV) by determining how well it identifies true cases of postoperative sepsis. ⋯ PSI 13 has relatively poor predictive ability to identify true cases of postoperative sepsis in both the VA and nonfederal sectors. The lack of information on diagnosis timing, confusion about the definition of elective admission, and coding limitations were the major reasons for false positives. As it currently stands, the use of PSI 13 as a stand-alone measure for hospital reporting appears premature.
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Multicenter Study
How valid is the AHRQ Patient Safety Indicator "postoperative physiologic and metabolic derangement"?
The Agency for Healthcare Research and Quality Patient Safety Indicator postoperative physiologic and metabolic derangement (PMD) uses ICD-9-CM codes to screen for potentially preventable acute kidney injury (AKI) requiring dialysis plus diabetes-related complications after elective surgery. Data on PMD's accuracy in identifying true events are limited. We examined the indicator's positive predictive value (PPV) in the Veterans Health Administration (VA). ⋯ Due to its low PPV, we recommend removing diabetes complications from the indicator and focusing on AKI. PMD's PPV could be significantly improved by using present-on-admission codes, and specific to the VA, by introduction of admission status codes. Many PMD-identified cases appeared to be at high risk based on patient- and procedure-related factors. The degree to which such cases are truly preventable events requires further assessment.