14.02 Measuring Surgical Outcomes in Rural Haiti: Choosing a Target for Quality Improvement

Posted on December 22, 2014

A. C. Matousek1,3, S. Addington1, C. Exe2, R. R. Jean-Louis2, J. G. Meara3,4, R. Riviello1,3  1The Center For Surgery And Public Health, Brigham And Women’s Hospital,Surgery,Boston, MA, USA 2Hospital Albert Schweitzer,Deschapelles, ARTIBONITE, Haiti 3Harvard Medical School,Program in Global Surgery And Social Change, Department Of Global Health And Social Medicine,Boston, MA, USA

Introduction:  The lack of outcome data is a barrier to quality improvement efforts in resource poor settings.  Most hospitals in LMICs endure several resource constraints and do not include outcome measurement in routine data collection.  We set out to systematically record inpatient surgical outcomes for an eight-month time period at a typical rural NGO hospital in rural Haiti to inform future quality improvement efforts.

Methods: A single data collector used a standard set of definitions to prospectively record outcomes during any admission or readmission for adult and pediatric general and orthopedic surgical patients from Sept 16th, 2013 to May 16th, 2014. Primary outcomes included all cause mortality, post-operative mortality, surgical site infection, and unplanned re-operation.  Secondary outcomes included length of stay and reasons for re-admission.

Results:  The cohort included 1088 patients and 1165 admissions.  The surgical caseload consisted of 1022 operations performed on 864 patients. All-cause mortality occurred in 1.52%, post-operative mortality in 1.45%, SSIs in 2.47%, and unplanned repeat operations in 1.40% of cases.  The 30-day readmission rate was 7.1%. Median Length of stay (LOS) for all patients was 4 days.  Median LOS for patients with diabetic foot ulcers was 30 days.  Readmissions were due to complications in 50% of cases.

Conclusions:  Measuring outcomes should precede attempts at quality improvement in order to identify the most relevant interventions.  For this hospital, we identify inpatient wound care as a target for quality improvement and encourage the development of outpatient metrics to more fully characterize surgical quality.