Key result
Including readmissions increased identified postoperative hemorrhage/hematoma events by 9.3%, indicating the current Patient Safety Indicator definition misses events and may need modification.
Cohort
Yes
The current Patient Safety Indicator definition for postoperative hemorrhage/hematoma misses events identified on readmission and may require modification to capture events without a secondary procedure.
May underreport events in quality metrics; leaves open whether PSI revision improves accuracy.
This study employed a retrospective cohort analysis using New York State's Statewide Planning and Research Cooperative System (SPARCS) to improve the Patient Safety Indicator (PSI) definition of postoperative hemorrhage/hematoma (POHH) and to identify patient risk factors associated with POHH. Study participants were nonobstetric, inpatient surgical admissions in SPARCS and readmissions within 30 days with a principal diagnosis of POHH. The main outcome measures were mortality rate, length of stay, and readmissions. The mortality rates of events identified by a secondary diagnosis only and by the PSI were not significantly different. The number of POHH events increased by 9.3% when readmissions were captured. The PSI definition of POHH may need modification to capture events with no secondary procedure. The PSI misses events identified on readmission, but the consequences of these events are not as severe as those currently captured. A variety of patient and hospital characteristics are predictive of a higher risk of POHH.
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Shufelt et al. (2005) conducted a cohort in Postoperative hemorrhage/hematoma. Patient Safety Indicator (PSI) definition was evaluated on Mortality rate, length of stay, and readmissions. Including readmissions increased identified postoperative hemorrhage/hematoma events by 9.3%, indicating the current Patient Safety Indicator definition misses events and may need modification.
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