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abstract
Background
Benchmarking
the quality of intraoperative care by comparing the rates of
intraoperative adverse events (iAEs) necessitates adequate risk
adjustment. We sought to identify the patient- and procedure-related
risk factors for iAEs.
Study Design
Our
2007 to 2012 institutional American College of Surgeons NSQIP and
administrative databases were linked and then screened for iAEs using
the Patient Safety Indicator “Accidental Puncture/Laceration.”
Intraoperative adverse events were confirmed by systematic review of
medical records. Comorbidities were assessed using American College of
Surgeons NSQIP variables. Adhesiolysis was determined using CPT codes
for lysis of adhesions. Operative complexity was determined using
relative value units. Multivariable models were constructed to identify
independent predictors of iAEs. Sensitivity analyses were performed in
uniform samples of operations.
Results
Of
9,292 patients, 218 iAEs were confirmed in 183 patients. Median patient
age was 56 years old and 54% were female. Compared with patients
without iAEs, iAE patients were older (median 61 vs 56 years; p <
0.001), more functionally dependent (9% vs 5%; p = 0.028), and had
higher American Society of Anesthesiologists class (≥3 in 45% vs 35%;
p = 0.004); their procedures were more complex (median relative value
units 29 vs 23; p < 0.001), more likely open (48% vs 21%; p <
0.001), and more often required adhesiolysis (44% vs 18%; p < 0.001).
In multivariable analyses, adhesiolysis (odds ratio = 2.34; 95% CI,
1.71–3.21; p < 0.001), higher operative complexity (third vs first
relative value units quartile: odds ratio = 3.36; 95% CI, 1.66–6.78; p
< 0.001; fourth vs first quartile: odds ratio = 5.97; 95% CI,
3.01–11.86; p < 0.001), and open surgical approach (odds ratio =
2.04; 95% CI, 1.39–3.01; p < 0.001) independently predicted iAEs.
Sensitivity analyses confirmed adhesiolysis and higher operative
complexity as independent iAE predictors.
Conclusions
Adhesiolysis
and higher operative complexity predict an increased risk for iAE.
Attempts to benchmark the quality of intraoperative care need to
adequately risk adjust for these factors.
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