Kuy SreyRam, Romero Ramon A L
Center for Innovations in Quality, Outcomes and Patient Safety, Surgical Service, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana; Department of Surgery, Louisiana State University School of Medicine-New Orleans, LSUHSC School of Medicine, New Orleans, Louisiana; Department of Health, Louisiana Medicaid, Baton Rouge, Louisiana.
Center for Innovations in Quality, Outcomes and Patient Safety, Surgical Service, Overton Brooks Veterans Affairs Medical Center, Shreveport, Louisiana; Department of Surgery, Louisiana State University School of Medicine-Shreveport, Shreveport, Louisiana.
J Surg Res. 2017 Jul;215:28-33. doi: 10.1016/j.jss.2017.03.030. Epub 2017 Apr 1.
The Overton Brooks VA Medical Center Surgical Service had a high mortality. In an effort to reduce surgical mortality, we implemented a series of quality improvement interventions, including utilization of the ACS Surgical Risk Calculator to identify high-risk surgical patients for discussion in a multidisciplinary Pre-Operative Consultation Committee.
Retrospective study describing the implementation of a risk stratification intervention incorporating the ACS Surgical Risk Calculator Tool and a multidisciplinary Pre-Operative Consultation Committee to target high-risk patients. Measurement of 30 day surgical mortality and risk adjusted Observed to Expected (O/E) mortality ratio.
From May 2013 to September 2014, 614 high-risk patients were selected utilizing the ACS Risk Calculator and presented at the Pre-Operative Consultation Committee. Following implementation of this risk stratification intervention, 30-day mortality decreased by 66% from 0.9% to 0.3%, and risk adjusted O/E mortality ratio decreased from 2.5 to 0.8. Among the high risk patients presented, there was no increase in referrals to other facilities. There was a significant increase in cases requiring further preoperative optimization, from 6.3% at the beginning of the study period to 17.5% at the end of the study period.
Implementation of a preoperative risk stratification intervention utilizing the ACS Surgical Risk Calculator along with a multidisciplinary Pre-Operative Consultation Committee can be successfully accomplished, with a significant decrease in 30-day surgical mortality. This is the first published report of utilization of the ACS Risk calculator as part of a systematic quality improvement tool to decrease surgical mortality.
奥弗顿·布鲁克斯退伍军人事务医疗中心外科服务的死亡率很高。为降低手术死亡率，我们实施了一系列质量改进干预措施，包括使用美国外科医师学会（ACS）手术风险计算器来识别高风险手术患者，以便在多学科术前咨询委员会中进行讨论。
回顾性研究描述了纳入ACS手术风险计算器工具和多学科术前咨询委员会以针对高风险患者的风险分层干预措施的实施情况。测量30天手术死亡率和风险调整后的观察到预期（O/E）死亡率比值。
从2013年5月到2014年9月，使用ACS风险计算器选择了614名高风险患者，并在术前咨询委员会中进行了陈述。实施这种风险分层干预措施后，30天死亡率从0.9%降至0.3%，下降了66%，风险调整后的O/E死亡率比值从2.5降至0.8。在提交的高风险患者中，转诊至其他机构的情况没有增加。需要进一步术前优化的病例显著增加，从研究期开始时的6.3%增至研究期末的17.5%。
利用ACS手术风险计算器以及多学科术前咨询委员会实施术前风险分层干预措施能够成功实现，30天手术死亡率显著降低。这是首篇发表的将ACS风险计算器用作系统性质量改进工具以降低手术死亡率一部分的报告。
