Risk-adjusted rates for potentially avoidable reoperations were computed from routine hospital data.

TitreRisk-adjusted rates for potentially avoidable reoperations were computed from routine hospital data.
Publication TypeJournal Article
Year of Publication2007
AuthorsHalfon, P, Eggli, Y, Matter, M, Kallay, C, van Melle, G, Burnand, B
JournalJ Clin Epidemiol
Volume60
Issue1
Pagination56-67
Date Published2007 Jan
DOI10.1016/j.jclinepi.2006.03.013
ISSN0895-4356
Mots-clésAdult, Aged, Algorithms, Female, Health Services Research, Hospitals, Humans, Male, Medical Errors, Medical Records, Middle Aged, Postoperative Complications, Prognosis, Quality Indicators, Health Care, Reoperation, Risk Factors, Surgical Procedures, Operative, Switzerland
Abstract

OBJECTIVES: Reoperations may reflect a suboptimal initial surgical treatment. The study aimed to develop a screening algorithm for those potentially avoidable, using only routinely collected hospital data and a prediction model to adjust rates for case-mix.

STUDY DESIGN AND SETTING: Data of a 3-year random sample of 7,370 therapeutic operations on inpatients, among which 833 were followed-up by a reoperation during the same stay. A review of medical records identified clearly avoidable and other potentially avoidable reoperations to develop and test the screening algorithm. A logistic prediction model of potentially avoidable reoperations was developed on one randomly chosen half of the data (about 9,000 interventions) and tested on the other half (cross-validation).

RESULTS: Two hundred thirty-seven interventions (3%) were followed by a potentially avoidable reoperation, among which 144 were clearly avoidable. The screening algorithm had a sensitivity of 75% and a specificity of 72%. Predictors of potentially avoidable reoperations were surgery categories, diagnosis related conditions, and experiencing prior surgery. The risk score, based on these variables, showed at once a satisfactory discriminative performance (C-statistic=0.76) and goodness-of-fit measure on the validation set.

CONCLUSION: The adjusted rate of potentially avoidable reoperations should be included in internal reporting of hospital quality indicators, but further validated in various settings.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/17161755?dopt=Abstract

Alternate JournalJ Clin Epidemiol
Citation Key / SERVAL ID2463
PubMed ID17161755
                         

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