Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery. Issue 8 (22nd November 2015)

• Record Type: Journal Article
• Authors: Scally, Christopher P.; Yin, Huiying; Birkmeyer, John D.; Wong, Sandra L.
• Is Part Of: Journal of surgical oncology. Volume 112:Issue 8(2015:Dec. 15)
• Page Start: 866
• Page End: 871
• Publication Date: 2015-11-22
• Subjects: quality improvement/trends -- quality of healthcare -- neoplasms/surgery -- inpatients/statistics and numerical data -- outcome and process assessment -- perioperative care; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.24085
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract : Background: Pancreatic surgery outcomes vary widely. We hypothesize that by comparing high and low mortality hospitals, we may identify differences in patient care impacting safety. Methods: We sampled hospitals with very‐low and very‐high mortality (LMH; HMH) and conducted on‐site chart reviews evaluating perioperative care practices for pancreatic operations. Results: HMHs had an 11.6% mortality rate; LMHs 1.5%. Patients in HMHs had worse ASA classification (20.9% ASA Class 4/5 vs. 2.0%, P < 0.001) and comorbidity burden (55.3% with ≥1 comorbidity vs. 39.6%, P = 0.037). At HMHs, operations took longer (353.9 min vs. 313.7 min, P = 0.05), had higher blood loss (1, 203.7 ml vs. 881.6 ml, P = 0.04), and patients underwent more transfusions (70.2% vs. 41.1%, P < 0.001). There were differences in anesthetic care: less invasive monitoring (76.1% vs. 93.1%, P < 0.001) and epidural pain management (22.5% vs. 62.9%, P < 0.001). Both cohorts had similar rates of VTE prophylaxis and SSI prevention compliance. Conclusion: High and low mortality hospitals both have high compliance with common quality measures; however, HMHs performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts. J. Surg. Oncol. 2015;112:866–871 . © 2015 Wiley Periodicals, Inc.