Medicare risk-adjusted outcomes in elective major vascular surgery.
Surgery
; 164(4): 831-838, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-29941284
ABSTRACT
BACKGROUND:
Risk-adjusted outcomes of elective major vascular surgery that is inclusive of inpatient and 90-day post-discharge adverse outcomes together have not been well studied.METHODS:
We studied 2012-2014 Medicare inpatients who received open aortic procedures, open peripheral vascular procedures, endovascular aortic procedures, and percutaneous angioplasty procedures of the lower extremity for risk-adjusted adverse outcomes of inpatient deaths, 3-sigma prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day post-discharge associated readmissions after excluding unrelated events. Observed and predicted total adverse outcomes for hospitals meeting minimum risk-volume criteria were assessed and hospital-specific z-scores and risk-adjusted adverse outcomes were calculated to compare performance.RESULTS:
The total adverse-outcome rate was 27.8% for open aortic procedures, 31.5% for open peripheral vascular procedures, 19.6% for endovascular aortic procedures, and 36.4% for percutaneous angioplasty procedures. The difference in risk-adjusted adverse-outcome rates between the best- and the poorest-performing deciles were 32.2% for open aortic procedures, 29.5% for open peripheral vascular procedures, 21.5% for endovascular aortic procedures, and 37.1% for percutaneous angioplasty procedures. The 90-day post-discharge deaths and readmissions were the major driver of overall adverse-outcome rates.CONCLUSION:
The variability in risk-adjusted outcomes among best- and poorest-performing hospitals is over 20% in all major vascular procedures and indicates that a large opportunity exists for improvement in results.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doenças Vasculares
/
Procedimentos Cirúrgicos Vasculares
/
Procedimentos Cirúrgicos Eletivos
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article