Hospital Outcomes in Inpatient Laparoscopic Cholecystectomy in Medicare Patients
Donald E Fry1, Michael Pine, Susan Nedza
1*MPA Healthcare Solutions, Chicago, IL †Departments of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL ‡University of New Mexico School of Medicine, Albuquerque, NM §Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Objective:
To compare the risk-adjusted outcomes of hospitals in inpatient Medicare laparoscopic cholecystectomy.
Background:
Reduced length-of-stay for inpatient surgical care requires the inclusion of objective postdischarge outcomes to provide a comprehensive assessment of hospital and surgeon performance for quality improvement.
Methods:
The 2010 to 2012 Medicare Limited Data Set was used to develop risk-adjusted prediction models of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths, and 90-day readmissions for inpatient laparoscopic cholecystectomy. To define the opportunity for improved performance, prediction models were used to compute z scores and risk-adjusted adverse outcome rates for all hospitals in the database that had 20 or more evaluable cases for the study period.
Results:
A total of 83,274 patients from 1570 hospitals had an overall adverse outcome rate of 20.7%; 48 hospitals had outcomes that were 2 z scores better than predicted and 76 had 2 z scores poorer than predicted. Risk-adjusted adverse outcomes were 10.0 % in the best performing decile of hospitals and were 32.1% in the poorest performing decile. Gastrointestinal, infectious, and cardiopulmonary complications of care were the most common causes of readmissions with 46.3% occurring between days 30 and 90 after discharge.
Conclusions:
Comparative analysis of overall risk-adjusted inpatient and 90-day postdischarge adverse outcomes identifies considerable opportunity for improved care in this high-risk population of patients.
