Key result
An ordered Textbook Outcome composite measure for bariatric surgery captured greater hospital variation (median POR 0.66) compared to a standard binomial outcome (median OR 0.91), enabling better identification of areas for quality improvement.
Why the study?
Previous binomial textbook outcome measures did not provide individual hospitals with the necessary information to improve performance, prompting the development of an ordered composite measure to assess hospital variation in bariatric surgery.
Does an ordered Textbook Outcome measure capture hospital variation better than a binary TO in patients undergoing primary bariatric surgery?
Observational (n=27,360)
Yes
Does an ordered Textbook Outcome measure capture hospital variation better than a binary TO in patients undergoing primary bariatric surgery?
Odds Ratio: 0.66
An ordered composite measure for Textbook Outcome in bariatric surgery captures more hospital variation than a binary measure, enabling targeted quality improvement.
Ordered TO identifies actionable hospital variation in bariatric surgery; leaves open validation and clinical adoption.
INTRODUCTION: Textbook outcome (TO) studies have previously shown that a composite measure can provide additional information on the overall quality of surgical care. However, these were binominal outcomes which do not give individual hospitals the required information on how to improve their performance. The aim of this study is to create an ordered TO consisting of multiple outcome parameters for bariatric surgery to assess the extent of hospital variation. METHODS: Patients who underwent a primary bariatric procedure in the Netherlands were included for analyses. The outcomes were ordered as mortality, severe postoperative complications, readmission, mild complications and prolonged length of stay (LOS) within 30 days after primary surgery with TO defined as none of these outcomes occurring. Hospitals were identified with a significantly higher or lower observed/expected ratio than expected based on case-mix and the extent of hospital variation was expressed as the median and interquartile range (IQR). RESULTS: From a total of 27,360 patients on average, 88.7% reached TO (range 35.5-96.9%). Two hospitals had less than expected TO due to more prolonged LOS (57.6%) in one hospital and more mild complications in another (17.1%). Hospital variation was much smaller for TO (median OR 0.91 IQR [0.62-1.06]) than for an ordered TO (median POR 0.66 IQR [0.55-0.96]). CONCLUSION: Using the ordered TO for bariatric surgery, more hospital variation was captured thereby enabling individual hospitals to identify which outcomes and specific groups need improvement. This could attribute to the ongoing effort to improve the quality of the outcome of bariatric surgery.
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Poelemeijer et al. (2018) conducted an observational in Primary bariatric surgery (n=27,360). Ordered Textbook Outcome (TO) composite measure vs. Binomial Textbook Outcome was evaluated on Hospital variation in achieving Textbook Outcome (median POR 0.66 (IQR 0.55-0.96)). An ordered Textbook Outcome composite measure for bariatric surgery captured greater hospital variation (median POR 0.66) compared to a standard binomial outcome (median OR 0.91), enabling better identification of areas for quality improvement.
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