Hospital Variation in Outcomes following Appendectomy in a Regional Quality Improvement Program
Objective To determine hospital variation in clinical outcomes following appendectomy for acute appendicitis. Methods Using data from the Michigan Surgical Quality Collaborative (MSQC), we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendic...
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| Veröffentlicht in: | The American journal of surgery 2016-11, Vol.212 (5), p.857-862 |
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| creator | Jenkins, Peter C., MD, MSc Oerline, Mary K., MS Mullard, Andrew J., MS Englesbe, Michael J., MD, FACS Campbell, Darrell A., MD, FACS Hemmila, Mark R., MD, FACS |
| description | Objective To determine hospital variation in clinical outcomes following appendectomy for acute appendicitis. Methods Using data from the Michigan Surgical Quality Collaborative (MSQC), we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006—2011). We used multivariate regression models for risk adjustment of patient level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates. Results During the study period, 12,410 patients underwent appendectomies in 49 participating MSQC hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference the rate of post-operative sepsis and septic shock. Conclusion We found significant hospital variation in outcomes following appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan. |
| doi_str_mv | 10.1016/j.amjsurg.2016.02.011 |
| format | Article |
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Methods Using data from the Michigan Surgical Quality Collaborative (MSQC), we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006—2011). We used multivariate regression models for risk adjustment of patient level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates. Results During the study period, 12,410 patients underwent appendectomies in 49 participating MSQC hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference the rate of post-operative sepsis and septic shock. Conclusion We found significant hospital variation in outcomes following appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2016.02.011</identifier><identifier>PMID: 27324383</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Adult ; Aged ; Appendectomy ; Appendectomy - adverse effects ; Appendectomy - methods ; Appendicitis ; Appendicitis - diagnosis ; Appendicitis - surgery ; Blood pressure ; Cardiopulmonary resuscitation ; Chronic obstructive pulmonary disease ; Classification ; Clinical outcomes ; Collaboration ; Consortia ; CPR ; Data collection ; Databases, Factual ; Diabetes ; Emergency general surgery ; Female ; Follow-Up Studies ; Heart attacks ; Hospitals ; Hospitals - trends ; Humans ; Infections ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Laparotomy - adverse effects ; Laparotomy - methods ; Length of Stay ; Male ; Medical personnel ; Medical records ; Middle Aged ; Mortality ; Multivariate Analysis ; Outcomes ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Quality ; Quality Improvement ; Regional quality improvement ; Regression Analysis ; Retrospective Studies ; Sepsis ; Surgery ; Treatment Outcome ; Urogenital system</subject><ispartof>The American journal of surgery, 2016-11, Vol.212 (5), p.857-862</ispartof><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Nov 01, 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-243435dbbb3395ee3b143fbf6d065abf10716e0c69939c4647c9730a2c773f093</citedby><cites>FETCH-LOGICAL-c481t-243435dbbb3395ee3b143fbf6d065abf10716e0c69939c4647c9730a2c773f093</cites><orcidid>0000-0002-0264-6951</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1833938299?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993,64383,64385,64387,72239</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27324383$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jenkins, Peter C., MD, MSc</creatorcontrib><creatorcontrib>Oerline, Mary K., MS</creatorcontrib><creatorcontrib>Mullard, Andrew J., MS</creatorcontrib><creatorcontrib>Englesbe, Michael J., MD, FACS</creatorcontrib><creatorcontrib>Campbell, Darrell A., MD, FACS</creatorcontrib><creatorcontrib>Hemmila, Mark R., MD, FACS</creatorcontrib><title>Hospital Variation in Outcomes following Appendectomy in a Regional Quality Improvement Program</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Objective To determine hospital variation in clinical outcomes following appendectomy for acute appendicitis. Methods Using data from the Michigan Surgical Quality Collaborative (MSQC), we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006—2011). We used multivariate regression models for risk adjustment of patient level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates. Results During the study period, 12,410 patients underwent appendectomies in 49 participating MSQC hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference the rate of post-operative sepsis and septic shock. Conclusion We found significant hospital variation in outcomes following appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Appendectomy</subject><subject>Appendectomy - adverse effects</subject><subject>Appendectomy - methods</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - surgery</subject><subject>Blood pressure</subject><subject>Cardiopulmonary resuscitation</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Classification</subject><subject>Clinical outcomes</subject><subject>Collaboration</subject><subject>Consortia</subject><subject>CPR</subject><subject>Data collection</subject><subject>Databases, Factual</subject><subject>Diabetes</subject><subject>Emergency general surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Hospitals - trends</subject><subject>Humans</subject><subject>Infections</subject><subject>Laparoscopy - adverse effects</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy - adverse effects</subject><subject>Laparotomy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Outcomes</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Quality</subject><subject>Quality Improvement</subject><subject>Regional quality improvement</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Urogenital system</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkk9v1DAQxS0EotvCRwBF4sIlwfYkjn0BVRWllSqV_1fLcSYrhyRe7KRovz0Ou4DUC5yskX7vzYzfEPKM0YJRJl71hRn7uIRtwVNZUF5Qxh6QDZO1ypmU8JBsKKU8V4LRE3IaY59Kxkp4TE54DbwECRuir3zcudkM2VcTnJmdnzI3ZbfLbP2IMev8MPgfbtpm57sdTi3a2Y_7FTHZR9wmPEk_LGZw8z67HnfB3-GI05y9D34bzPiEPOrMEPHp8T0jXy7ffr64ym9u311fnN_ktpRsztM0JVRt0zQAqkKEJg3aNZ1oqahM0zFaM4HUCqVA2VKUtVU1UMNtXUNHFZyRlwffNMH3BeOsRxctDoOZ0C9RMwk1sFLS6j9QLmrKpZAJfXEP7f0S0sq_DEGB5GrtXR0oG3yMATu9C240Ya8Z1WtYutfHsPQalqZcpySS7vnRfWlGbP-ofqeTgDcHANPP3TkMOlqHk8XWhRSEbr37Z4vX9xzs4CZnzfAN9xj_bqNjEuhP68WsB8MEUKZUCT8B_ha8Hg</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Jenkins, Peter C., MD, MSc</creator><creator>Oerline, Mary K., MS</creator><creator>Mullard, Andrew J., MS</creator><creator>Englesbe, Michael J., MD, FACS</creator><creator>Campbell, Darrell A., MD, FACS</creator><creator>Hemmila, Mark R., MD, FACS</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0264-6951</orcidid></search><sort><creationdate>20161101</creationdate><title>Hospital Variation in Outcomes following Appendectomy in a Regional Quality Improvement Program</title><author>Jenkins, Peter C., MD, MSc ; Oerline, Mary K., MS ; Mullard, Andrew J., MS ; Englesbe, Michael J., MD, FACS ; Campbell, Darrell A., MD, FACS ; Hemmila, Mark R., MD, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-243435dbbb3395ee3b143fbf6d065abf10716e0c69939c4647c9730a2c773f093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Appendectomy</topic><topic>Appendectomy - adverse effects</topic><topic>Appendectomy - methods</topic><topic>Appendicitis</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - surgery</topic><topic>Blood pressure</topic><topic>Cardiopulmonary resuscitation</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Classification</topic><topic>Clinical outcomes</topic><topic>Collaboration</topic><topic>Consortia</topic><topic>CPR</topic><topic>Data collection</topic><topic>Databases, Factual</topic><topic>Diabetes</topic><topic>Emergency general surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Hospitals - trends</topic><topic>Humans</topic><topic>Infections</topic><topic>Laparoscopy - adverse effects</topic><topic>Laparoscopy - methods</topic><topic>Laparotomy - adverse effects</topic><topic>Laparotomy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Outcomes</topic><topic>Patients</topic><topic>Postoperative Complications - 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Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jenkins, Peter C., MD, MSc</au><au>Oerline, Mary K., MS</au><au>Mullard, Andrew J., MS</au><au>Englesbe, Michael J., MD, FACS</au><au>Campbell, Darrell A., MD, FACS</au><au>Hemmila, Mark R., MD, FACS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital Variation in Outcomes following Appendectomy in a Regional Quality Improvement Program</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>212</volume><issue>5</issue><spage>857</spage><epage>862</epage><pages>857-862</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Objective To determine hospital variation in clinical outcomes following appendectomy for acute appendicitis. Methods Using data from the Michigan Surgical Quality Collaborative (MSQC), we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006—2011). We used multivariate regression models for risk adjustment of patient level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates. Results During the study period, 12,410 patients underwent appendectomies in 49 participating MSQC hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference the rate of post-operative sepsis and septic shock. Conclusion We found significant hospital variation in outcomes following appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27324383</pmid><doi>10.1016/j.amjsurg.2016.02.011</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-0264-6951</orcidid></addata></record> |
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| subjects | Acute Disease Adult Aged Appendectomy Appendectomy - adverse effects Appendectomy - methods Appendicitis Appendicitis - diagnosis Appendicitis - surgery Blood pressure Cardiopulmonary resuscitation Chronic obstructive pulmonary disease Classification Clinical outcomes Collaboration Consortia CPR Data collection Databases, Factual Diabetes Emergency general surgery Female Follow-Up Studies Heart attacks Hospitals Hospitals - trends Humans Infections Laparoscopy - adverse effects Laparoscopy - methods Laparotomy - adverse effects Laparotomy - methods Length of Stay Male Medical personnel Medical records Middle Aged Mortality Multivariate Analysis Outcomes Patients Postoperative Complications - epidemiology Postoperative Complications - physiopathology Quality Quality Improvement Regional quality improvement Regression Analysis Retrospective Studies Sepsis Surgery Treatment Outcome Urogenital system |
| title | Hospital Variation in Outcomes following Appendectomy in a Regional Quality Improvement Program |
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