Y. Chen1, R. Anand1, L. Ly1, J. Cedarbaum1, A. Hjelmaas1, S. Collins2, S. Regenbogen2 1University Of Michigan,Medical School,Ann Arbor, MI, USA 2University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction:
For Value-Based Purchasing (VBP) and public reporting of surgical outcomes to fairly reflect performance, hospital-based metrics of postoperative complications require balanced comparisons between hospitals. Colectomy is a central component of the Hospital Acquired Infections VBP metric, yet there is no attempt to account for differences in the indication for surgery. Using data from a population-based, statewide collaborative, we sought to understand what influence inflammatory bowel disease (IBD) might have on outcomes after colectomy, and how a greater share of IBD surgery might alter a hospital’s performance score.
Methods:
This retrospective cohort study draws on data collected from the Michigan Surgical Quality Collaborative (MSQC), a network of 73 Michigan hospitals that prospectively collects data on surgical patient characteristics and outcomes. Among patients who underwent elective colectomy between 2012 and 2015, we compared rates of surgical site infection (SSI), bleeding, sepsis, and urinary tract infection (UTI) for those with IBD, compared with other indications, using chi-square tests for proportions.
Results:
Among the 7271 colectomy patients evaluated, the 297 with IBD had significantly higher rates of organ space SSI (6.7% vs. 2.6%, p<0.0001) and bleeding (8.4% vs. 5.7%, p=0.05). IBD patients also had higher, but not statistically different rates of superficial SSI (5.4% vs. 3.7%, p=0.15), deep SSI (2.0% vs. 1.1%, p=0.12), and sepsis (6.1% vs. 4.1%, p=0.11). There was no difference in the rate of UTI (p=0.97).
Conclusion:
Among patients in the MSQC who underwent non-emergent colectomy, those with IBD had significantly higher rates of organ space SSI and postoperative bleeding. Recognizing that organ space SSI is a core component of VBP metrics, and postoperative bleeding is an Agency for Healthcare Research and Quality endorsed Patient Safety Indicator, hospitals that specialize in the care of IBD may be unjustly identified as high outliers for these and other postoperative adverse events. These findings highlight the importance of detailed risk assessment in surgical outcomes evaluation, especially when it may determine reimbursement penalties.
