Current Quality Measurement Tools Are Insufficient to Assess Complications in Orthopedic Surgery

详细信息    查看全文

• 作者：Arjun S. Sebastian ; MD^&lowast ; ; Stephanie F. Polites ; MD^&dagger ; ; Amy E. Glasgow ; BS^&Dagger ; ; Elizabeth B. Habermann ; PhD^&Dagger ; ; Robert R. Cima ; MD^&dagger ; ; Sanjeev Kakar ; MD^&lowast ; ; ^{kakar.sanjeev@mayo.edu}
• 关键词：Quality ; American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) ; Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI)
• 刊名：The Journal of Hand Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：42
• 期：1
• 页码：10-15.e1
• 全文大小：262 K
• 卷排序：42

文摘

The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) is a clinically-derived, validated tool to track outcomes in surgery. The Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) are a set of computer algorithms run on administrative data to identify adverse events. The purpose of this study is to compare complications following orthopedic surgery identified by ACS-NSQIP and AHRQ-PSI.MethodsPatients between 2010 and 2012 who underwent orthopedic procedures (arthroplasty, spine, trauma, foot and ankle, hand, and upper extremity) at our tertiary-care, academic institution were identified (n = 3,374). Identification of inpatient adverse events by AHRQ-PSI in the cohort was compared with 30-day events identified by ACS-NSQIP. Adverse events common to both AHRQ-PSI and ACS-NSQIP were infection, sepsis, venous thromboembolism, bleeding, respiratory failure, wound disruption, and renal failure. Concordance between AHRQ-PSI and ACS-NSQIP for identifying adverse events was examined.ResultsA total of 729 adverse events (21.6%) were identified in the cohort using ACS-NSQIP methodology and 35 adverse events (1.0%) were found using AHRQ-PSI. Only 12 events were identified by both methodologies. The most common complication was bleeding in ACS-NSQIP (18.1%) and respiratory failure in AHRQ-PSI (0.53%). The overlap was highest for venous thromboembolic events. There was no overlap in adverse events for 5 of the 7 categories of adverse events.ConclusionsA large discrepancy was observed between adverse events reported in ACS-NSQIP and AHRQ-PSI. A large percentage of clinically important adverse events identified in ACS-NSQIP were missed in AHRQ-PSI algorithms. The ability of AHRQ-PSI for detecting adverse events varied widely with ACS-NSQIP.Clinical relevanceAHRQ-PSI algorithms currently are insufficient to assess the quality of orthopedic surgery.