• Spinal cord · Apr 2016

    Establishing standard hospital performance measures for cervical spinal trauma: a Nationwide In-patient Sample study.

    • D J Hoh, M Rahman, K M Fargen, D Neal, and B L Hoh.
    • Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
    • Spinal Cord. 2016 Apr 1; 54 (4): 306-13.

    Study DesignA retrospective national administrative database study.ObjectivePatient safety indicators (PSIs) and hospital-acquired conditions (HACs) are metrics for quality of health care and are linked to reimbursement. The prevalence of PSIs/HACs may impact access to health care for certain conditions. We estimated the national occurrence rates of PSIs/HACs among cervical trauma patients and identified patient factors that correlate with their occurrence.SettingUnited States of America.MethodsWe queried Nationwide In-patient Sample database (NIS) hospitalizations (2002-2010) for diagnoses of cervical fracture with and without spinal cord injury (SCI). The incidence of each PSI/HAC was determined by ICD-9 (International Classification of Disease, 9th Revision) codes. Multivariate analysis was used to identify the correlation between specific variables and the probability of each indicator.ResultsThere were 52,377 hospitalizations for cervical fracture in the NIS (without SCI, n = 41,708; with SCI, n = 10,669). Among those without SCI, there were 5374 (12.9%) reported PSIs and 117 (0.3%) HACs. Leading adverse events were postoperative respiratory failure (8.45%), pulmonary embolism (1.70%) and pressure ulcer (1.12%). Among those with SCI, there were 6600 (61.9%) PSIs and 143 (1.3%) HACs. Leading adverse events were postoperative respiratory failure (39.2%), pressure ulcer (7.78%), sepsis (5.71%), deep venous thrombosis (3.81%) and PE (1.70%). Adverse events were associated with several factors, including age, gender, Comorbidity Score and Injury Severity Score. Those with ⩾ 1 PSI/HAC had significantly longer lengths of stay (P < 0.0001) and higher hospital costs (P < 0.0001) and mortality (P < 0.0001) compared with patients without events.ConclusionsThese results estimate baseline national rates of PSIs/HACs in patients with cervical spine trauma. These data may be used to gauge individual institutional quality of care in comparison with national data.

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