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Bergman S, Deban M, Martelli V, Monette M, Sourial N, Hamadani F, Teasdale D, Holcroft C, Zakrzewski H, Fraser S. Association between quality of care and complications after abdominal surgery. Surgery 2013; 156:632-9. [PMID: 24656856 DOI: 10.1016/j.surg.2013.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/27/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications. METHODS This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression. RESULTS The mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI. CONCLUSION Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives.
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Affiliation(s)
- Simon Bergman
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Melina Deban
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vanessa Martelli
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michèle Monette
- Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nadia Sourial
- Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Fadi Hamadani
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Debby Teasdale
- Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Christina Holcroft
- Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Helena Zakrzewski
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shannon Fraser
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Reissmann DR, Semmusch J, Farhan D, Smeets R, Heiland M, Heydecke G. Development and validation of the Burdens in Oral Surgery Questionnaire (BiOS-Q). J Oral Rehabil 2013; 40:780-7. [DOI: 10.1111/joor.12092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- D. R. Reissmann
- Department of Prosthetic Dentistry; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Division of TMD and Orofacial Pain; Department of Diagnostic and Biological Sciences; University of Minnesota; Minneapolis MN USA
| | - J. Semmusch
- Department of Oral and Maxillofacial Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - D. Farhan
- Department of Prosthetic Dentistry; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - R. Smeets
- Department of Oral and Maxillofacial Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Heiland
- Department of Oral and Maxillofacial Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - G. Heydecke
- Department of Prosthetic Dentistry; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Twijnstra ARH, Blikkendaal MD, van Zwet EW, Jansen FW. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol 2013; 20:64-72. [PMID: 23312244 DOI: 10.1016/j.jmig.2012.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVES To estimate the current conversion rate in laparoscopic hysterectomy (LH); to estimate the influence of patient, procedure, and performer characteristics on conversion; and to hypothesize the extent to which conversion rate can act as a means of evaluation in LH. DESIGN Prospective cohort study (Canadian Task Force classification II-2). SETTING The study included 79 gynecologists representing 42 hospitals throughout the Netherlands. This reflects 75% of all gynecologists performing LH in the Netherlands, and 68% of all hospitals. PATIENTS Data from 1534 LH procedures were collected between 2008 and 2010. INTERVENTION All participants in the nationwide LapTop registration study recorded each consecutive LH they performed during 1 year. MEASUREMENTS AND MAIN RESULTS Conversion rate and odds ratios (OR) of risk factors for conversion were calculated. Conversions were described as reactive or strategic. The literature reported a conversion rate for LH of 0% to 19% (mean, 3.5%). In our cohort, 70 LH procedures (4.6%) were converted. Using a mixed-effects logistic regression model, we estimated independent risk factors for conversion. Body mass index (BMI) (p = .002), uterus weight (p < .001), type of LH (p = .004), and age (p = .02) had a significant influence on conversion. The risk of conversion was increased at BMI >35 (OR, 6.53; p < .001), age >65 years (OR, 6.97; p = .007), and uterus weight 200 to 500 g (OR, 4.05; p < .001) and especially >500 g (OR, 30.90; p < .001). A variation that was not explained by the covariates included in our model was identified and referred to as the "surgical skills factor" (average OR, 2.79; p = .001). CONCLUSION Use of estimated risk factors (BMI, age, uterus weight, and surgical skills) provides better insight into the risk of conversion. Conversion rate can be used as a means of evaluation to ensure better outcomes of LH in future patients.
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Mohammad WM, Martel G, Mimeault R, Fairfull-Smith RJ, Auer RC, Balaa FK. Evaluating agreement regarding the resectability of colorectal liver metastases: a national case-based survey of hepatic surgeons. HPB (Oxford) 2012; 14:291-7. [PMID: 22487066 PMCID: PMC3384848 DOI: 10.1111/j.1477-2574.2012.00440.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The resectability of colorectal liver metastases is in part largely based on the surgeon's assessment of cross-sectional imaging. This process, while guided by principles, is subjective. The objective of the present study was to assess agreement between hepatic surgeons regarding the resectability of colorectal liver metastases. METHODS Forty-six hepatic surgeons across Canada were invited. A patient with biologically favourable disease was presented after having received neoadjuvant chemotherapy. The scenario was matched with 10 different scrollable abdominal CT scans representing a maximum response after six cycles of chemotherapy. Surgeons were asked to offer an opinion on resectability of liver metastases, and whether they would use adjunct modalities to hepatic resection. RESULTS Twenty-six surgeons participated. Twenty responses were complete. The median number of scenarios deemed resectable was 6/10 (range 3-8). Two control scenarios demonstrated perfect agreement. Agreement on resectability was poor for 4/8 test scenarios, of which one scenario demonstrated complete disagreement. Among resectable cases, the pattern of use of adjunct modalities was variable. A median ratio of 0.87 adjunct modality per resectable scenario per surgeon was used (range 0.25-1.75). CONCLUSION A significant lack of agreement was identified among surgeons on the resectability and use of adjunct modalities in the treatment of colorectal liver metastases.
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Affiliation(s)
- Waleed M Mohammad
- Liver and Pancreas Unit, Division of General Surgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
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Patient safety risk factors in minimally invasive surgery: a validation study. ACTA ACUST UNITED AC 2011; 9:265-270. [PMID: 22837734 PMCID: PMC3401291 DOI: 10.1007/s10397-011-0718-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/05/2011] [Indexed: 11/07/2022]
Abstract
This study was conducted to adapt and validate a patient safety (PS) framework for minimally invasive surgery (MIS) as a first step in understanding the clinical relevance of various PS risk factors in MIS. Eight patient safety risk factor domains were identified using frameworks from a systems approach to patient safety. A questionnaire was drafted containing 34 questions. Three experts in the field of patient safety critically reviewed the questionnaire on clinical relevance and completeness. The questionnaire was distributed among known patient safety experts in person and also sent electronically. A total of 41 questionnaires were distributed and the response rate was 71%. The intraclass correlation coefficient was 0.42 representing moderate agreement. For seven of nine risk domains, Cronbach’s alpha was sufficient (α > 0.7). Mean scores of the risk domains showed the following order of influence on patient safety from high to low: surgeon’s experience [6.6, standard deviation (SD) 0.5], technical skills surgeon (6.6, SD 0.7), technology (5.9, SD 1.1), complications (5.9, SD 1.2), social interaction (5.0, SD 1.0), leadership surgeon (5.4, SD 1.2), blood loss (5.0, SD 1.2), length of surgery (5.0, SD 1.3), surgical team (4.9, SD 1.3), fallibility (4.9, SD 1.3), patient (4.5, SD 1.5), safety measures (4.4, SD 1.5), and finally environment(3.9, SD 1.5). This study is an initiative to give insight into clinical relevance of the maze of PS risk factors in MIS. All investigated risk domains were considered to be of noticeable influence on PS. Nevertheless, it is possible to prioritize various risk domains. In fact, experience and technical skills of the surgeon, technology, and complications are rated as the most important risk factors, closely followed by social interaction and leadership of the surgeon. Patient, safety measures, and environment are rated as the least important risk factors.
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Risk factors in patient safety: minimally invasive surgery versus conventional surgery. Surg Endosc 2011; 26:350-6. [PMID: 21898021 PMCID: PMC3261399 DOI: 10.1007/s00464-011-1874-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/29/2011] [Indexed: 12/31/2022]
Abstract
Background This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS). Methods A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of the predefined patient safety risk domains. Results A total of 53 procedures were observed: 26 CS and 27 MIS procedures. The general characteristics were comparable between the two groups. A large number of environmental events were observed, averaging one every 2.5 min. Technical events and events of an organizational nature occurred more often in MIS (P < 0.01) than in CS (P < 0.01). The relative risk for the occurrence of one or more technical events in MIS compared with CS was 1.7, and the risk for two or more technical events was 4.1. A time out according to protocol showed no relationship to the occurrence of the different types of patient safety-related events. Conclusion The technological complexity inherent in MIS makes this type of surgery more prone to technology-related problems than CS, even in a specially designed minimally invasive surgical suite. A regular time-out procedure developed for CS lacks the attention necessary for the complex technology used in MIS and therefore is insufficient for MIS procedures briefing. Incorporating a specially designed technology checklist in a regular briefing protocol could be a solution to decrease the number of events in MIS.
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