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Usefulness of a state‐legislated, comparative database to evaluate quality in colorectal surgery

 

作者: Tito Gorski,   Lester Rosen,   Susan Lawrence,   Douglas Helfrich,   James Reed,  

 

期刊: Diseases of the Colon & Rectum  (OVID Available online 1999)
卷期: Volume 42, issue 11  

页码: 1381-1387

 

ISSN:0012-3706

 

年代: 1999

 

出版商: OVID

 

关键词: Colon;Comparative study;Databases, factual;Pennsylvania;Quality indicators, health care;Rectum;Surgical procedures, operative

 

数据来源: OVID

 

摘要:

PURPOSE:Colorectal surgery, a high‐volume procedure, has been targeted for performance improvement to reduce length of stay. Specific postoperative quality indicators and readmission rates should be analyzed concomitantly to assure that adverse events are not associated with earlier discharge.METHODS:From July 1, 1990, to June 30, 1997, 1,218 consecutive patients who underwent transabdominal colorectal surgery were analyzed for length of stay, mortality, morbidity, and discharge disposition. Each patient was assigned an Admission Severity Group rating 0 to 4 using a hospital‐based state‐legislated software system (Atlas™) to validate comparative performance internally and externally. Readmission data within 120 days of discharge were available for the last 678 consecutive patients from July 1, 1993, to June 30, 1997, using Lastword™ (computerized medical records).RESULTS:The annual frequencies of the 1,218 procedures were 173, 183, 175, 146, 167, 189, and 185, respectively, from July 1990 through June 1997. Severity distribution was 32 for Admission Severity Group 0, 517 for Admission Severity Group 1, 540 for Admission Severity Group 2, 128 for Admission Severity Group 3, and 1 for Admission Severity Group 4, with no annual difference (P=0.012). There was a significant reduction in total length of stay of 3.1 (12.9‐9.8) days during the seven years (P=0.001). The overall operative mortality rate was 1.4 percent, and the morbidity was 2.6 percent, with no annual differences (P=0.655 andP=0.033, respectively). The disposition to home did not change (P=0.21). Of the 678 patients followed up for readmission, 100 (14.7 percent) were readmitted within 120 days, with no annual difference (P=0.302).CONCLUSION:Mortality, morbidity, disposition, and readmission rates were not affected by a decreased length of stay after colorectal surgery.

 

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