Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Surgery. 2011 Nov;150(5):943-9. doi: 10.1016/j.surg.2011.06.020. Epub 2011 Aug 27.
Evaluating surgical outcomes is an important tool to compare providers and institutions and to drive process improvements. Differing methodologies, however, may provide conflicting measurements of similar clinical outcomes making comparisons difficult. ACS-NSQIP is a validated, risk-adjusted, clinically derived data methodology to compare observed to expected outcomes after a wide variety of operations. The AHRQ-PSI are a set of computer algorithms to identify potential adverse in-patient events using secondary ICD-9-CM diagnosis and procedure codes from hospital discharge abstracts.
We compared the ACS-NSQIP and AHRQ-PSI methods for hospital general surgical (n = 6565) or vascular surgical inpatients procedures (n = 1041) at a tertiary-care academic institution from April 2006 to June 2009 on 7 adverse event types.
ACS-NSQIP inpatient adverse events were identified in 564 (7.4%) patients. AHRQ-PSIs were identified in 268 (3.5%) patients. Only 159 (2.1%) patients had inpatient events identified by both methods. Using ACS-NSQIP as the clinically based standard the sensitivity of the specific AHRQ-PSI ranged from 0.030 for infections to 0.535 for PE/DVT. Positive predictive values of AHRQ-PSI ranged from 18% for hemorrhage/hematoma to 89% for renal failure. Greater agreement at greater ASA class and wound classification was observed.
AHRQ-PSI algorithms identified less than a third of the ACS-NSQIP clinically important adverse events. Furthermore, the AHRQ-PSI identified a large number of events with no corresponding clinically important adverse outcomes. The sensitivity of the AHRQ-PSI for detecting clinically relevant adverse events identified by the ACS-NSQIP varied widely. The AHRQ-PSI as applied to postoperative patients is a poor measure of quality performance.
评估手术结果是比较提供者和机构并推动流程改进的重要工具。然而，不同的方法可能会对相似的临床结果提供相互矛盾的衡量标准，从而使比较变得困难。ACS-NSQIP 是一种经过验证的、风险调整的、临床衍生的数据方法，用于比较各种手术后的实际结果与预期结果。AHRQ-PSI 是一组使用医院出院摘要中的次要 ICD-9-CM 诊断和程序代码来识别潜在不良住院事件的计算机算法。
我们比较了 2006 年 4 月至 2009 年 6 月在一家三级学术医疗机构进行的普外科（n=6565）或血管外科住院患者手术（n=1041）的 ACS-NSQIP 和 AHRQ-PSI 方法，共涉及 7 种不良事件类型。
ACS-NSQIP 住院不良事件在 564 名（7.4%）患者中得到识别。AHRQ-PSIs 在 268 名（3.5%）患者中被识别。只有 159 名（2.1%）患者同时通过两种方法确定了住院事件。使用 ACS-NSQIP 作为基于临床的标准，特定 AHRQ-PSI 的灵敏度从感染的 0.030 到 PE/DVT 的 0.535 不等。AHRQ-PSI 的阳性预测值从出血/血肿的 18%到肾衰竭的 89%不等。在更高的 ASA 分级和伤口分类中观察到更大的一致性。
AHRQ-PSI 算法仅识别了不到三分之一的 ACS-NSQIP 临床重要不良事件。此外，AHRQ-PSI 识别出大量没有相应临床重要不良后果的事件。AHRQ-PSI 检测 ACS-NSQIP 识别的临床相关不良事件的灵敏度差异很大。应用于术后患者的 AHRQ-PSI 是衡量质量绩效的一个较差指标。
