Key result
In 5,285 surgical procedures, poor antibiotic choice, PACU hypothermia, and preoperative WBC >11,000/mm were associated with 3- to 4-fold increases in mortality (P<0.05 to P<0.01).
Why the study?
What are the predictors of morbidity and mortality and the adherence rates to Surgical Care Improvement Project measures in surgical specialty procedures?
Cohort (n=5,285)
Yes
What are the predictors of morbidity and mortality and the adherence rates to Surgical Care Improvement Project measures in surgical specialty procedures?
The study identifies significant gaps in perioperative quality measures, such as beta-blocker continuation and glucose control, and highlights predictors of surgical mortality.
Supports risk stratification by functional status and ASA class; leaves open randomized confirmation of modifiable factors.
OBJECTIVE: To identify opportunities for improvement in quality performance profile while maintaining better clinical outcomes. METHODS: A prospective study of 5285 surgical specialty procedures including hip and knee replacement, cholecystectomy, hysterectomy, nonaccess vascular and cardiac procedures, and colorectal resections in 16 Kentucky hospitals was undertaken. The following observations were made after univariate and stepwise logistic regression analysis, from the Surgical Care Improvement Project. RESULTS: (1) Impaired functional status, age > or =65, and ASA class 4 or 5 status were significant predictors for both morbidity and mortality. (2) beta blockade medication was maintained in only 70% of patients already receiving such medications; interestingly, vascular surgery and patients with known cardiac history did not have beta blockade initiated 52% of the time. (3) Appropriate blood glucose control was not achieved in 31% of patients with diabetes and in 20% of nondiabetics. (4) deep vein thrombosis (DVT) prophylaxis was independent of high-risk status, with wide variation in practice. Patients undergoing total hip or knee replacement or colorectal resections had highest rates (0.7%) of pulmonary emboli. (5) A poor choice of antibiotic prophylaxis agent occurred in 8% of patients and was associated with a 3-fold increase in mortality (P < 0.01). (6) Hypothermia on arrival in PACU was present in 7% of patients after major colorectal resections and was ominously associated with an over 4-fold increase in mortality (P < 0.01). (7) Preoperative WBC >11,000/mm in elective operations was associated with nearly 3-fold increase in mortality (P < 0.05). CONCLUSION: Now more than ever, surgeons must verify performance measures and outcomes. This study of clinical outcomes permits identification of underappreciated contemporary risk factors and some obvious measures by which surgical practices can more objectively be evaluated.
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Mahid et al. (2008) conducted a cohort in Surgical specialty procedures (n=5,285). Perioperative risk factors and performance measures was evaluated on Morbidity and mortality. In 5,285 surgical procedures, poor antibiotic choice, PACU hypothermia, and preoperative WBC >11,000/mm were associated with 3- to 4-fold increases in mortality (P<0.05 to P<0.01).
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