Association Between Leapfrog Safe Practices Score and Hospital Mortality in Major Surgery

Background: The Leapfrog Group reports on hospitals' adoption of the National Quality Forum Patient Safety Practices. However, it is unknown whether hospital compliance with these safe practices is associated with improved outcomes in patients undergoing major surgery. Methods: We analyzed the association between hospital mortality and Leapfrog Safe Practices among patients undergoing coronary artery bypass graft surgery (n = 18,565), abdominal aortic aneurysm repair (n = 2777), and hip replacement (n = 25,067) in hospitals participating in the 2007 Leapfrog Hospital Survey using logistic regression. Results: After adjusting for patient and hospital factors, we found that the total safety score (adjusted odds ratio: 1.000, 95% confidence interval: 0.999-1.001) was not associated with hospital mortality. Computerized physician order entry and ICU physician staffing were also not associated with hospital mortality. Conclusions: We did not find evidence that patients undergoing major surgery at hospitals which scored higher on the Leapfrog Safe Practices Survey had lower mortality rates. The Leapfrog safe practices score as a standalone quality measure may have limited power to distinguish between high-quality and low-quality hospitals.