Restating Surgical Risk: From Patient to Population

Area of Science:

• Healthcare Management
• Surgical Outcomes
• Health Services Research

Background:

• Federal legislation is shifting healthcare payments from fee-for-service to alternative models.
• Risk recognition is crucial for developing appropriate payment systems under new healthcare legislation.
• Bundled population cohorts will be a key component of future payment negotiations.

Purpose of the Study:

• To compare the risk and outcomes of surgical patients at an urban safety net teaching hospital with state and national cohorts.
• To identify preoperative risk factors with significantly higher incidence in the safety net population.
• To evaluate changes in risk factor incidence and their impact on surgical outcomes over time.

Main Methods:

• Analysis of deidentified summary data from 2013 and 2014.
• Comparison of a safety net teaching hospital's surgical population with statewide and national academic center cohorts.
• Assessment of preoperative risk factors, 30-day mortality, readmissions, return to operating room, length of stay, and adverse events.

Main Results:

• Safety net hospital had >50% higher incidence of smoking, ventilator dependence, and congestive heart failure (CHF).
• Septic shock, diabetes, CHF, and hypertension incidence increased in 2014 at the safety net hospital.
• Despite higher risks, 30-day mortality, readmissions, return to OR, and LOS were comparable to state/national cohorts.

Conclusions:

• The safety net hospital's population exhibits greater risk due to a higher incidence of comorbid conditions.
• Increased smoking-related pathology and need for ventilator support contribute to higher care costs.
• Risk recognition, reduction, and resolution are vital for cost-efficient surgical outcomes in evolving payment models.