Preoperative and intraoperative risk factors associated with 30-day morbidity following urological surgery: the National Surgical Quality Improvement Program.

PURPOSE

The National Surgical Quality Improvement Program was established in 1994 to measure and enhance of the quality of surgical care. Since its inception, 30-day postoperative morbidity after major surgery in the Veterans Administration has decreased by 45%. We performed a pilot study to assess risk factors associated with 30-day morbidity using National Surgical Quality Improvement Program indicators in a private setting.

MATERIALS AND METHODS

A total of 643 subjects were accrued by a trained surgical reviewer from our institution between December 2003 and December 2004. Patient preoperative, intraoperative and nonNational Surgical Quality Improvement Program data elements were abstracted from clinical records. Bivariate relationships between preoperative risk factors, intraoperative process measures and 30-day postoperative morbidity were determined. Multiple variable logistic regression analysis was used to identify patient preoperative and intraoperative risk factors associated with 30-day morbidity.

RESULTS

On multivariate analysis the preoperative risk factors history of congestive heart failure (OR 14.42, 95% CI 2.66 to 78.30), diabetes with end organ damage (OR 12.56, 95% CI 2.09 to 75.53), angioplasty (OR 2.75, 95% CI 1.27 to 5.93), quadriplegia (OR 4.39, 95% CI 1.36 to 14.14), low albumin (OR 2.49, 95% CI 1.18 to 5.24) and hydronephrosis (OR 2.51, 95% CI 1.11 to 5.69) were statistically significant predictors of 30-day postoperative morbidity. Intraoperative process measures, that is operative time in hours (OR 1.24, 95% CI 1.12 to 1.37) and transfusion (OR 3.11, 95% CI 1.49 to 6.50), were also significant contributors to postoperative morbidity.

CONCLUSIONS

We found that patient preoperative risk factors and intraoperative process measures were important determinants of postoperative morbidity. Implementation of the National Surgical Quality Improvement Program in urology may be used to measure processes of care that are associated with surgical outcomes and, thereby, improve the quality of urological care.