• Simon Bergman, Melina Deban, Vanessa Martelli, Michèle Monette, Nadia Sourial, Fadi Hamadani, Debby Teasdale, Christina Holcroft, Helena Zakrzewski, and Shannon Fraser.
• Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: simon.bergman@mcgill.ca.
• Surgery. 2014 Sep 1;156(3):632-9.

BackgroundMeasuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications.MethodsThis retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression.ResultsThe mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI.ConclusionHigher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives.Copyright © 2014 Mosby, Inc. All rights reserved.

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