Wound classification reporting in HPB surgery

Can a single word change public perception of institutional performance?

Paul J. Speicher, Daniel P. Nussbaum, John E. Scarborough, Sabino Zani, Rebekah R. White, Dan G. Blazer, Christopher R. Mantyh, Douglas Tyler, Bryan M. Clary

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated.

Methods The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI.

Results In total, 27 376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification.

Conclusions Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.

Original languageEnglish (US)
Pages (from-to)1068-1073
Number of pages6
JournalHPB
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Fingerprint

Surgical Wound Infection
Wounds and Injuries
Odds Ratio
Quality Improvement
Documentation
Logistic Models
Databases
Guidelines

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Speicher, P. J., Nussbaum, D. P., Scarborough, J. E., Zani, S., White, R. R., Blazer, D. G., ... Clary, B. M. (2014). Wound classification reporting in HPB surgery: Can a single word change public perception of institutional performance? HPB, 16(12), 1068-1073. https://doi.org/10.1111/hpb.12275

Wound classification reporting in HPB surgery : Can a single word change public perception of institutional performance? / Speicher, Paul J.; Nussbaum, Daniel P.; Scarborough, John E.; Zani, Sabino; White, Rebekah R.; Blazer, Dan G.; Mantyh, Christopher R.; Tyler, Douglas; Clary, Bryan M.

In: HPB, Vol. 16, No. 12, 01.12.2014, p. 1068-1073.

Research output: Contribution to journalArticle

Speicher, PJ, Nussbaum, DP, Scarborough, JE, Zani, S, White, RR, Blazer, DG, Mantyh, CR, Tyler, D & Clary, BM 2014, 'Wound classification reporting in HPB surgery: Can a single word change public perception of institutional performance?', HPB, vol. 16, no. 12, pp. 1068-1073. https://doi.org/10.1111/hpb.12275
Speicher PJ, Nussbaum DP, Scarborough JE, Zani S, White RR, Blazer DG et al. Wound classification reporting in HPB surgery: Can a single word change public perception of institutional performance? HPB. 2014 Dec 1;16(12):1068-1073. https://doi.org/10.1111/hpb.12275
Speicher, Paul J. ; Nussbaum, Daniel P. ; Scarborough, John E. ; Zani, Sabino ; White, Rebekah R. ; Blazer, Dan G. ; Mantyh, Christopher R. ; Tyler, Douglas ; Clary, Bryan M. / Wound classification reporting in HPB surgery : Can a single word change public perception of institutional performance?. In: HPB. 2014 ; Vol. 16, No. 12. pp. 1068-1073.
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abstract = "Introduction The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated.Methods The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI.Results In total, 27 376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8{\%} of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification.Conclusions Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.",
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