August 17, 2004JAMA
Surgical Mortality as an Indicator of Hospital Quality
Key result
Except for CABG surgery (90%), hospitals rarely meet the minimum 3-year caseloads required to reliably use surgical mortality as a quality indicator for major procedures (range <1% to 33%).
Why the study?
Are the 7 operations for which mortality has been advocated as a quality indicator performed frequently enough to reliably identify hospitals with increased mortality rates?
Population
US hospitals performing 7 operations in the 2000 Nationwide Inpatient Sample
Design
Cross-sectional
Authors
Discussion
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Member takes
Implication
Mortality rates should not yet guide hospital quality assessment except after CABG; challenges consensus on their reliability and leaves open alternative metrics.
Study Design
Type
Observational
Multicenter
Yes
Structured PICO
Are the 7 operations for which mortality has been advocated as a quality indicator performed frequently enough to reliably identify hospitals with increased mortality rates?
P
Population
US hospitals performing 7 operations (coronary artery bypass graft [CABG] surgery, repair of abdominal aortic aneurysm, pancreatic resection, esophageal resection, pediatric heart surgery, craniotomy, hip replacement) in the 2000 Nationwide Inpatient Sample (NIS)
O
Outcome
Proportion of hospitals in the United States that performed more than the minimum caseload for each operation to reliably detect increased mortality rates
Except for CABG surgery, most operations advocated for surgical mortality quality indicators are not performed frequently enough at most hospitals to reliably judge hospital quality.
Cite This Study
Dimick et al. (2004) conducted an observational in Surgical procedures used as hospital quality indicators. Hospital caseloads was evaluated on Proportion of hospitals in the United States that performed more than the minimum caseload for each operation. Except for CABG surgery (90%), hospitals rarely meet the minimum 3-year caseloads required to reliably use surgical mortality as a quality indicator for major procedures (range <1% to 33%).