Abstract
Background
Increasing evidence demonstrates significant variation in adverse outcomes following surgery between countries. In order to better quantify these variations, we hypothesize that freely available online risk calculators can be used as a tool to generate global benchmarking of risk-adjusted surgical outcomes.
Methods
This is a prospective cohort study conducted at an academic teaching hospital in South Africa (GSH). Consecutive adult patients undergoing major general or vascular surgery who met the ACS-NSQIP inclusion criteria for a 3-month period were included. Data variables required by the ACS risk calculator were prospectively collected, and patients were followed for 30 days post-surgery for the occurrence of endpoints. Calculating observed-to-expected ratios for ten outcome measures of interest generated risk-adjusted outcomes benchmarked against the ACS-NSQIP consortium.
Results
A total of 373 major general and vascular surgery procedures met the inclusion criteria. The GSH operative cohort varied significantly compared to the 2012 ACS-NSQIP database. The risk-adjusted O/E ratios were significant for any complication O/E 1.91 (95 % CI 1.57–2.31), surgical site infections O/E 4.76 (95 % CI 3.71–6.01), renal failure O/E 3.29 (95 % CI 1.50–6.24), death O/E 3.43 (95 % CI 2.19–5.11), and total length of stay (LOS) O/E 3.43 (95 % CI 2.19–5.11).
Conclusion
Freely available online risk calculators can be utilized as tools for global benchmarking of risk-adjusted surgical outcomes.
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References
Ingraham AM, Richards KE, Hall BL et al (2010) Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg 44:251–267
Birkmeyer JD, Shahian DM, Dimick JB et al (2008) Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program. J Am Coll Surg 207(5):777–782
Cohen ME, Liu Y, Ko CY et al (2015) Improved surgical outcomes for ACS NSQIP hospitals over time: evaluation of hospital cohorts with up to 8 years of participation. Ann Surg 263(2):267–273
Dimick JB, Osborne NH, Hall BL et al (2010) Risk adjustment for comparing hospital quality with surgery: how many variables are needed? J Am Coll Surg 210(4):503–508
Hall BL, Hamilton BH, Richards K et al (2009) Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 250(3):363–376
Henderson WG, Daley J (2009) Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is? Am J Surg 198(5 Suppl):S19–S27. doi:10.1016/j.amjsurg.2009.07.025
Haider AH, Saleem T, Leow JJ et al (2012) Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact? J Am Coll Surg 214(5):756–768
Birkmeyer JD, Dimick JB, Birkmeyer NJ (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198(4):626–632
Farmer DL (2012) NSQIP lite: a potential tool for global comparative effectiveness evaluations. Arch Surg 147(9):803–804
Cohen ME, Bilimoria KY, Ko CY et al (2009) Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg 208(6):1009–1016
Paruch JL, Ko CY, Bilimoria KY (2014) An opportunity to improve informed consent and shared decision making: the role of the ACS NSQIP surgical risk calculator in oncology. Ann Surg Oncol 21(1):5–7
Parikh P, Shiloach M, Cohen ME et al (2010) Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB (Oxford) 12(7):488–497
Khavanin N, Kim JY, Davila AA et al (2014) Abstract 46: the BRA score: creating a general risk calculator for breast reconstruction outcomes. Plast Reconstr Surg 133(3 Suppl):56–57
Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217(5):833–842
Khuri SF, Henderson WG, Daley J et al (2008) Successful implementation of the department of veterans affairs’ national surgical quality improvement program in the private sector: the patient safety in surgery study. Ann Surg 248(2):329–336
Debas HT, Donker P, Gawande A, et al (2015) Disease control priorities: essential surgery. http://www.dcp-3.org/surgery. Accessed 01 Sept 2015
Meara JG, Leather AJ, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386(9993):569–624
World Health Organisation (2015) World health assembly resolution 15 Aug 2015. http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R15-en.pdf. Accessed 01 Sept 2015
Rose J, Weiser TG, Hider P et al (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health 27(3 Suppl 2):S13–S20
Meara JG, Greenberg SL (2015) Global surgery as an equal partner in health: no longer the neglected stepchild. Lancet Glob Health 27(3 Suppl 2):S1–S2
Mock C (2015) A banner year for global surgery: now how to make it make a difference on the ground. World J Surg 39(9):2111–2114. doi:10.1007/s00268-015-3154-x
Meara JG, Leather AJ, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery 386(9993):569–624
Ariyaratnam R, Palmqvist CL, Hider P et al (2015) Toward a standard approach to measurement and reporting of perioperative mortality rate as a global indicator for surgery. Surgery 158(1):17–26
Haider AH, Hashmi ZG, Gupta S et al (2014) Benchmarking of trauma care worldwide: the potential value of an International Trauma Data Bank (ITDB). World J Surg 38(8):1882–1891. doi:10.1007/s00268-014-2629-5
Andersen J, Lassiter R, Bickler S et al (2012) Brief tool to measure risk-adjusted surgical outcomes in resource-limited hospitals. Arch Surg 147(9):798–803
Haynes SR, Lawler PG (1995) An assessment of the consistency of ASA physical status classification allocation. Anaesthesia 50(3):195–199
Hoffmann M, Lefering R, Rueger JM et al (2012) Pupil evaluation in addition to glasgow coma scale components in prediction of traumatic brain injury and mortality. Br J Surg 99(Suppl 1):122–130
Schluter PJ (2011) The trauma and injury severity score (TRISS) revised. Injury 42(1):90–96
Cohen ME, Bilimoria KY, Ko CY et al (2009) Effect of subjective preoperative variables on risk-adjusted assessment of hospital morbidity and mortality. Ann Surg 249(4):682–689
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Spence, R.T., Chang, D.C., Chu, K. et al. An Online Tool for Global Benchmarking of Risk-Adjusted Surgical Outcomes. World J Surg 41, 24–30 (2017). https://doi.org/10.1007/s00268-016-3668-x
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DOI: https://doi.org/10.1007/s00268-016-3668-x