Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

PURPOSE: The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. METHODS: The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. RESULTS: The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CONCLUSION: CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients.

Validity of the clinical and administrative databases in detecting post-operative adverse events.

OBJECTIVE: Patient safety has become a major public health concern and a priority for multiple institutions. Assessment of the adverse events is a key element for measuring the quality of healthcare organizations. The aim of this study was to measure the validity of the clinical and administrative database (CADB) as a source of information for the detection of post-operative adverse events. DESIGN: The study design was cross-sectional. SETTING: The study was carried out at the Hospital de Navarra (north of Spain). PARTICIPANTS: The sample consisted of 1602 episodes of surgical hospitalization from nine surgical departments. Two sources of information were used: data extracted from the complete clinical record (CR), the gold standard, vs. the CADB. MAIN OUTCOMES: Rate of adverse events, sensitivity, positive predictive value and κ index were analysed for 28 types of post-operative adverse event. Each index was considered acceptable if it had a value >0.6. RESULTS: The rate of adverse events using the CADB was 12.5 vs. 24% using CR within 30 days of surgery (P = 0.0001) and 13.9% using CR during a hospital stay (P > 0.05). The overall sensitivity of the CADB in the detection of adverse events was 0.18, and the positive predictive value was 0.34. Two adverse events (accounted for 6% of the total events detected) had moderate validity and the rest poor validity. Forty-two per cent of the adverse events took place after patient discharge. CONCLUSIONS: Although the use of CADB is appealing, the present study suggests that it is of very limited value in the detection of adverse events post-operatively.

[Atypical fibroxanthoma. Clinical/pathological study of 10 cases]. / Fibroxantoma atípico. Estudio clinicopatológico de 10 casos.

INTRODUCTION: Atypical fibroxanthoma (AFX) is a rare tumor of unknown histogenesis, considered by most authorities as a superficial form of malignant fibrous histiocytoma (MFH). The aim of this work is to report the clinicopathological features of 10 cases of AFX. MATERIAL AND METHODS: Data were retrospectively collected of the computerized medical history. Clinical (age, onset-diagnosis time, location, accompanying pathology, outcome), histological (architectural pattern, cell type, ulceration, vascular or perineural invasion, subcutis involvement, pleomorphism, mitosis, inflammatory infiltrate) and immunohistochemical variable were analyzed. CASES REPORT: Clinical and epidemiological features coincide with those previously reported: onset late in life, short time onset-diagnosis, involvement of skin with notable sun damage and a good outcome. Pathologically all the cases showed a spindle-cell prevalence arranged in a vaguely storiform pattern, along with both, multinucleated and eosinophilic cells. DISCUSSION: The diagnosis of AXF is always of exclusion. Other spindle-cell tumors such as squamous cell carcinoma, malignant melanoma, leyomiosarcoma or dermatofibrosarcoma protuberans must be ruled out by immunohistochemical techniques. In spite of its rarity, the recognition of AFX is important in order to avoid inappropriately aggressive treatment.