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Never events after hepatopancreatobiliary operations
Jeffrey J Siracuse1, Munizay Paracha1, Alik Farber1
1Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
American Journal of Surgery
|August 28, 2018
Summary
Never events (NE) in hepatopancreatobiliary (HPB) surgery patients are poorly understood. Despite policy changes, NE incidence has not improved, leading to worse patient outcomes, necessitating further intervention.
Area of Science:
- Hepatopancreatobiliary (HPB) surgery
- Patient safety
- Healthcare policy
Background:
- Never events (NE) are serious, preventable medical errors.
- The Centers for Medicare & Medicaid Services (CMS) stopped reimbursing for NE in 2008.
- NE in HPB surgery patients remain poorly understood.
Purpose of the Study:
- To investigate the incidence and effects of NE in HPB surgery patients.
- To analyze trends in NE before and after the CMS reimbursement policy change.
Main Methods:
- Utilized the Nationwide Inpatient Sample (NIS) database.
- Analyzed data from 57,436 HPB patients from 2003-2011.
- Compared NE incidence, demographics, outcomes, and predictors between pre- and post-mandate cohorts.
Main Results:
- NE occurred in 1.1% of HPB patients, with higher rates after pancreas surgery (1.4%).
- The most common NE were falls (43%) and vascular-catheter-associated infections (28%).
- NE incidence increased overall after the CMS policy change, and specific patient factors (e.g., paralysis, metastatic cancer) were correlated with NE.
Conclusions:
- HPB surgery patients experiencing NE have significantly worse outcomes.
- Current CMS policy changes have not reduced NE incidence in this population.
- Additional strategies are required to reduce NE in HPB surgery patients.
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