National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA

Objectives While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national tr...

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Bibliographic Details
Published in:BMJ open 2013-01, Vol.3 (6), p.e002843
Main Authors: Sukumar, Shyam, Roghmann, Florian, Trinh, Vincent Q, Sammon, Jesse D, Gervais, Mai-Kim, Tan, Hung-Jui, Ravi, Praful, Kim, Simon P, Hu, Jim C, Karakiewicz, Pierre I, Noldus, Joachim, Sun, Maxine, Menon, Mani, Trinh, Quoc-Dien
Format: Article
Language:English
Subjects:
Cancer
Cancer surgery
Datasets
Economic indicators
Epidemiology
Health care policy
Hospitals
Medicaid
Medicare
Mortality
Oncology
Patient safety
Patients
Studies
Trends
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Summary:Objectives While multiple studies have demonstrated variations in the quality of cancer care in the USA, payers are increasingly assessing structure-level and process-level measures to promote quality improvement. Hospital-acquired adverse events are one such measure and we examine their national trends after major cancer surgery. Design Retrospective, cross-sectional analysis of a weighted-national estimate from the Nationwide Inpatient Sample (NIS) undergoing major oncological procedures (colectomy, cystectomy, oesophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy and prostatectomy). The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were utilised to identify trends in hospital-acquired adverse events. Setting Secondary and tertiary care, US hospitals in NIS Participants A weighted-national estimate of 2 508 917 patients (>18 years, 1999–2009) from NIS. Primary outcome measures Hospital-acquired adverse events. Results 324 852 patients experienced ≥1-PSI event (12.9%). Patients with ≥1-PSI experienced higher rates of in-hospital mortality (OR 19.38, 95% CI 18.44 to 20.37), prolonged length of stay (OR 4.43, 95% CI 4.31 to 4.54) and excessive hospital-charges (OR 5.21, 95% CI 5.10 to 5.32). Patients treated at lower volume hospitals experienced both higher PSI events and failure-to-rescue rates. While a steady increase in the frequency of PSI events after major cancer surgery has occurred over the last 10 years (estimated annual % change (EAPC): 3.5%, p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2013-002843