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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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
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Cancer
Cancer surgery
Datasets
Economic indicators
Epidemiology
Health care policy
Hospitals
Medicaid
Medicare
Mortality
Oncology
Patient safety
Patients
Studies
Trends
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cited_by cdi_FETCH-LOGICAL-b472t-2e053acdb945c770aac77947130c47a4d104a3ea4daeff4e57d08cd46ae1978b3
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creator 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
description 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
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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 (&gt;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&lt;0.001), a concomitant decrease in failure-to-rescue rates (EAPC −3.01%) and overall mortality (EAPC −2.30%) was noted (all p&lt;0.001). Conclusions Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2013-002843</identifier><identifier>PMID: 23804313</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Cancer ; Cancer surgery ; Datasets ; Economic indicators ; Epidemiology ; Health care policy ; Hospitals ; Medicaid ; Medicare ; Mortality ; Oncology ; Patient safety ; Patients ; Studies ; Trends</subject><ispartof>BMJ open, 2013-01, Vol.3 (6), p.e002843</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2013 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b472t-2e053acdb945c770aac77947130c47a4d104a3ea4daeff4e57d08cd46ae1978b3</citedby><cites>FETCH-LOGICAL-b472t-2e053acdb945c770aac77947130c47a4d104a3ea4daeff4e57d08cd46ae1978b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1785356460/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1785356460?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,727,780,784,885,3194,25753,27549,27550,27924,27925,37012,37013,44590,53791,53793,75126,77594,77595,77601,77632</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23804313$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sukumar, Shyam</creatorcontrib><creatorcontrib>Roghmann, Florian</creatorcontrib><creatorcontrib>Trinh, Vincent Q</creatorcontrib><creatorcontrib>Sammon, Jesse D</creatorcontrib><creatorcontrib>Gervais, Mai-Kim</creatorcontrib><creatorcontrib>Tan, Hung-Jui</creatorcontrib><creatorcontrib>Ravi, Praful</creatorcontrib><creatorcontrib>Kim, Simon P</creatorcontrib><creatorcontrib>Hu, Jim C</creatorcontrib><creatorcontrib>Karakiewicz, Pierre I</creatorcontrib><creatorcontrib>Noldus, Joachim</creatorcontrib><creatorcontrib>Sun, Maxine</creatorcontrib><creatorcontrib>Menon, Mani</creatorcontrib><creatorcontrib>Trinh, Quoc-Dien</creatorcontrib><title>National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>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 (&gt;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&lt;0.001), a concomitant decrease in failure-to-rescue rates (EAPC −3.01%) and overall mortality (EAPC −2.30%) was noted (all p&lt;0.001). Conclusions Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.</description><subject>Cancer</subject><subject>Cancer surgery</subject><subject>Datasets</subject><subject>Economic indicators</subject><subject>Epidemiology</subject><subject>Health care policy</subject><subject>Hospitals</subject><subject>Medicaid</subject><subject>Medicare</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Patient safety</subject><subject>Patients</subject><subject>Studies</subject><subject>Trends</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><recordid>eNqNkc1q3DAUhUVpaEKSJygUQTfdONWvZW8KQ2iSQmgWSdbiWr6e8WBbHskeyNtXk5mEaVfVQrqSvnO40iHkM2dXnMv8e9Wv_YhDJhiXGWOiUPIDORNMqSxnWn88qk_JZYxrlobSpdbiEzkVsmBKcnlG8DdMrR-go1PAoY60HejKx7GdoMvAbeY2YE3HgFscJqg6pFBvMUSkryeRQjNhoD2sfaAOBpc2cQ5LDC87q2mF9PlxcUFOGugiXh7Wc_J88_Pp-i67f7j9db24zyplxJQJZFqCq6tSaWcMA0hzqQyXzCkDquZMgcRUADaNQm1qVrha5YC8NEUlz8mPve84Vz3WLnUYoLNjaHsIL9ZDa_--GdqVXfqtlXmZF4Ylg28Hg-A3M8bJ9m102HUwoJ-j5dKIhJaFSOjXf9C1n0P6yUSZQkudq3xnKPeUCz7GgM17M5zZXZL2kKTdJWn3SSbVl-N3vGveckvA1R5I6v9y_ANNyavw</recordid><startdate>20130101</startdate><enddate>20130101</enddate><creator>Sukumar, Shyam</creator><creator>Roghmann, Florian</creator><creator>Trinh, Vincent Q</creator><creator>Sammon, Jesse D</creator><creator>Gervais, Mai-Kim</creator><creator>Tan, Hung-Jui</creator><creator>Ravi, Praful</creator><creator>Kim, Simon P</creator><creator>Hu, Jim C</creator><creator>Karakiewicz, Pierre I</creator><creator>Noldus, Joachim</creator><creator>Sun, Maxine</creator><creator>Menon, Mani</creator><creator>Trinh, Quoc-Dien</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130101</creationdate><title>National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA</title><author>Sukumar, Shyam ; 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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 (&gt;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&lt;0.001), a concomitant decrease in failure-to-rescue rates (EAPC −3.01%) and overall mortality (EAPC −2.30%) was noted (all p&lt;0.001). Conclusions Over the past decade, there has been a substantial increase in the national frequency of potentially avoidable adverse events after major cancer surgery, with a detrimental effect on numerous outcome-level measures. However, there was a concomitant reduction in failure-to-rescue rates and overall mortality rates. Policy changes to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers and respiratory failure, are required.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23804313</pmid><doi>10.1136/bmjopen-2013-002843</doi><oa>free_for_read</oa></addata></record>
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source BMJ Open Access Journals; Publicly Available Content Database; BMJ Journals; PubMed Central
subjects Cancer
Cancer surgery
Datasets
Economic indicators
Epidemiology
Health care policy
Hospitals
Medicaid
Medicare
Mortality
Oncology
Patient safety
Patients
Studies
Trends
title National trends in hospital-acquired preventable adverse events after major cancer surgery in the USA
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