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Titolo:
Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery
Autore:
Pronovost, P; Garrett, E; Dorman, T; Jenckes, M; Webb, TH; Breslow, M; Rosenfeld, B; Bass, E;
Indirizzi:
Johns Hopkins Univ, Sch Med, Dept Anesthesiol CCM, Baltimore, MD 21287 USAJohns Hopkins Univ Baltimore MD USA 21287 ol CCM, Baltimore, MD 21287 USA Johns Hopkins Univ, Sch Med, Sch Hyg & Publ Hlth, Baltimore, MD 21287 USA Johns Hopkins Univ Baltimore MD USA 21287 l Hlth, Baltimore, MD 21287 USA
Titolo Testata:
LANGENBECKS ARCHIVES OF SURGERY
fascicolo: 4, volume: 386, anno: 2001,
pagine: 249 - 256
SICI:
1435-2443(200107)386:4<249:VICRAO>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADVERSE DRUG EVENTS; OPERATIVE MORTALITY; HOSPITAL VOLUME; INTENSIVE-CARE; ANEURYSMS; DISEASE; OUTCOMES; SYSTEMS; UNITS;
Keywords:
outcome; quality; complications; variation; aortic surgery;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Pronovost, P Johns Hopkins Univ, Sch Med, Dept Anesthesiol CCM, 600 N Wolfe St,Meyer 297A, Baltimore, MD 21287 USA Johns Hopkins Univ 600 N Wolfe St,Meyer 297A Baltimore MD USA 21287
Citazione:
P. Pronovost et al., "Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery", LANG ARCH S, 386(4), 2001, pp. 249-256

Abstract

Background. The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery. Patients/methods. We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely representmajor surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeonvolumes. Discharge data was obtained from the hospital marketing departments. Results. Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death includecardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval(CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure. Conclusions. In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated withincreased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/01/20 alle ore 15:04:09