Journal of the American College of Surgeons
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Comparative Study
Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study.
Surgical site infection (SSI) is a potentially preventable complication. We developed and tested a model to predict patients at high risk for surgical site infection. ⋯ We developed and tested an accurate prediction score for SSI. Clinicians can use this score to predict their patient's risk of an SSI and implement appropriate prevention strategies.
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Comparative Study
Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study.
Postoperative respiratory failure (RF) is associated with an increase in hospital morbidity, mortality, cost, and late mortality. We developed and tested a model to predict the risk of postoperative RF in patients undergoing major vascular and general surgical operations. This model is an extension of an earlier model that was derived and tested exclusively from a population of male patients from the Veterans Affairs National Surgical Quality Improvement Program. ⋯ This model updates a previously validated one and is more broadly applicable. Its use to predict postoperative RF risk enables the study of preventative measures or preoperative risk adjustment and intervention to improve outcomes.
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In 1985, Congress mandated that the Department of Veterans Affairs (VA) compare its risk-adjusted surgical results with those in the private sector. The National Surgical Quality Improvement Program was developed as a result, in the VA system, and subsequently trialed in 14 university medical centers in the private sector. This report examines the results of the comparison between patient characteristics and outcomes of female general surgical patients in the two health care environments. ⋯ The data demonstrate that in female general surgical patients, risk-adjusted mortality rates are comparable in the VA and the private sector, but risk-adjusted morbidity is higher in the private sector. Rates of urinary tract infections in the two populations may account for much of the latter difference.
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With increased focus on improving surgical care quality, understanding structures and processes that influence surgical care is timely and important, as is more precise specification of these through improved measurement. ⋯ Surgical care team members reinforced the importance of understanding surgical care processes and structures to improve both quality and outcomes of surgical care. The analysis of interviews helped the study team identify potential measures of structures and processes to include in our quantitative survey.