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Orthopaedic Surgery Complications at a Tertiary Care Hospital in a Low- and Middle-Income Country: A National
Syed Hashir Hasan1, Usman Ali, Junaid Khan
1From the Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan (Dr. Hasan, Dr. Ali, Dr. Khan and Dr. Noordin); Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan (Dr. Zafar); Department of Infection Prevention & Hospital Epidemiology, Aga Khan University Hospital, Karachi, Pakistan (Ms. Jivani and Ms. Ziauddin); University of Toronto, Ontario, Canada (Ms. Pidani).
Insights
This study compared Pakistani orthopaedic surgery outcomes to international standards using the National Surgical Quality Improvement Project (NSQIP). While some areas need improvement, like renal failure, others, such as venous thromboembolism, met expectations.
Area of Science:
- Healthcare Quality Improvement
- Surgical Outcomes Research
- Comparative Effectiveness
Background:
- Orthopaedic surgical care at a Pakistani tertiary care hospital was benchmarked against international standards.
- The study utilized data from the National Surgical Quality Improvement Project (NSQIP) registry.
Purpose of the Study:
- To identify areas for improvement in orthopaedic surgical care.
- To assess performance against international benchmarks.
- To guide system-level changes for enhanced patient outcomes.
Main Methods:
- Analysis of 584 orthopaedic surgeries performed in 2021.
- Comparison of complication rates with American College of Surgeons-NSQIP participant hospitals.
- Data collection by two reviewers over 8-day intervals to minimize bias.
- Reporting of results using odds ratios (OR) and quarterly/annual institutional reports.
Main Results:
- Higher odds ratios (OR) observed for cardiac events, surgical site infections, mortality, and morbidity.
- Notably high renal failure rates in Q3 (OR 4.57) and Q4 (OR 10.31).
- NSQIP 2021 report identified sepsis, surgical site infections, and cardiac complications as areas needing improvement, while venous thromboembolism (VTE) performance was exemplary.
Conclusions:
- The findings provide critical insights for the orthopaedic department to implement system-level changes.
- Subsequent interventions showed favorable outcomes in the 2022 NSQIP report.
- Continued efforts are necessary to further reduce adverse events and enhance patient outcomes and quality.
Background:
Through a comparison of orthopaedic surgical procedures performed at a tertiary care hospital in Pakistan with other participating hospitals of National Surgical Quality Improvement Project (NSQIP), we aim to identify the areas of orthopaedic surgical care at our center that need improvement and also those which are at par with international standards.
Methods:
The study analyses orthopaedic surgeries at a tertiary care hospital in Pakistan using NSQIP registry to compare complication rates with other American College of Surgeons-NSQIP participant hospitals. Two reviewers collect data in different days every 8 days to reduce bias, and the results are reported in odds ratios using quarterly reports. This study included 584 eligible orthopaedic cases performed in 2021. Yearly institutional reports with odds ratios were also used to identify areas needing improvement and to implement changes to improve orthopaedic surgical outcomes at said institute.
Results:
The quarterly reports suggest a relatively higher OR for certain indicators such as cardiac events, surgical site infection, mortality, and morbidity throughout. The renal failure rate was very high in the third and fourth quarters with odds ratios of 4.57 and 10.31, respectively. However, the official NSQIP annual institutional report for 2021 identified sepsis, surgical site infections, and cardiac complications as areas 'needing improvement'. It also indicated that the hospital performed exemplarily when it came to venous thromboembolism (VTE). As for the rest of the indicators, the hospital fell in the 'as expected' category of the NSQIP standards.
Conclusion:
This initial report helps the hospital's orthopaedic department in recognizing areas for improvement and making system-level changes to improve patient outcomes. The implementation of these interventions has yielded favorable outcomes, as evidenced by the findings in the NSQIP yearly report for 2022. Reinforcements and measures are needed to be taken to reduce the adverse events even further and to improve the patient outcomes and quality.
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