Improving postoperative sepsis performance measurement using hospital risk-adjustment and concomitant monitoring of prevention and rescue within a statewide surgical collaborative Public

Abstract

Background

The Georgia Quality Improvement Program (GQIP) surgical collaborative has shown poor performance in postoperative sepsis compared to national benchmarks in NSQIP. Reporting quality metrics in a collaborative setting facilitates best practice dissemination. We aimed to evaluate additional quality metrics along the surgical care pathway by calculating risk-adjusted postoperative sepsis rates as well as sepsis prevention and mortality rescue for GQIP hospitals. 

Methods 

The cohort included intra-abdominal general surgery patients across 10 GQIP hospitals from 2015-2020. ACS-NSQIP data were utilized to train and validate a multivariable model with postoperative sepsis as the outcome. This model was used to rank hospitals by risk-adjusted postoperative sepsis rates. Failure to prevent (FTP) was calculated by dividing postoperative sepsis occurrences by postoperative infectious complications. Failure to rescue (FTR) was defined as mortality after postoperative sepsis. Crude and risk-adjusted FTR were calculated. Complication management quality metrics were compared to risk-adjusted postoperative sepsis rankings.  

Results 

The study included 20,314 patients with 595 cases of postoperative sepsis. Hospital crude postoperative sepsis risk ranged from 0.81 to 5.11. When applying the risk-adjustment model 9 of 10 hospitals were re-ranked, and 4 changed performance tertile. FTP rates trended upward and correlated with risk-adjusted sepsis rankings. Crude and risk-adjusted FTR did not correlate with sepsis prevention or risk-adjusted postoperative sepsis rankings.  

Conclusions 

Postoperative sepsis complication management quality metrics are important to present in collaborative settings. They do not always correlate and provide important benchmarks along the surgical care pathway to guide precise targets for quality improvement. 

Table of Contents

1.    Aim 1 and Aim 2

2.    Manuscript Describing Aims 1 & 2

a.    Background

b.    Methods

c.    Results

d.    Discussion

e.    References

f.     Tables/Figures

i.    Table I, Figure I, Figure II, Figure III

3.    Aim 3 and Aim 4

4.    Manuscript Describing Aims 3 & 4

a.    Background

b.    Methods

c.    Results

d.    Discussion

e.    References

f.     Tables/Figures

i.    Table I, Figure I, Table II, Figure II

About this Master's Thesis

Rights statement

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Surgery Health Sciences, Health Care Management
Mot-clé	Postoperative Sepsis
Committee Chair / Thesis Advisor	Joe Sharma, Emory University
Committee Members	Amita Manatunga, Emory University Rachel Patzer, Emory University

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