The quality metric prolonged length of stay misses clinically important adverse events Journal Article
| Authors: | Farjah, F.; Lou, F.; Rusch, V. W.; Rizk, N. P. |
| Article Title: | The quality metric prolonged length of stay misses clinically important adverse events |
| Abstract: | The National Quality Forum endorses prolonged length of stay of more than 14 days (PLOS) as a quality metric for lobectomy for lung cancer. Because PLOS rates are lower than complication rates, we hypothesized that PLOS misses a significant proportion of clinically important events. A retrospective study was performed on patients undergoing lobectomy (2000 to 2009). The severity of adverse events was based on the National Cancer Institute common terminology criteria for adverse events (grade 2 or higher indicates symptoms or need for medical intervention; grade 5 indicates death). Among 2,667 patients, 163 (6%) experienced PLOS and 773 (29%) experienced an adverse event. Although the frequency of adverse events was higher among the PLOS group (99% [161 of 163] versus 24% [612 of 2504]), 79% (612 of 773) of adverse events occurred in the non-PLOS group. Whereas PLOS was associated with more severe events, 89% of those in the non-PLOS group experienced a grade 2 or higher event. Likewise, although PLOS was associated with the lowest 5-year survival rate (31%), patients in the non-PLOS group who had an adverse event had significantly lower survival rates than patients in the non-PLOS group who did not have any adverse events (55% versus 68%, p < 0.001; adjusted hazard ratio 1.3 [95% confidence interval: 1.1 to 1.6]). The PLOS missed a high proportion of adverse events defined by the need for ongoing inpatient therapy and an association with poor long-term survival. These findings have implications for efficient and fair performance assessment in the setting of a quality improvement program. © 2012 The Society of Thoracic Surgeons. |
| Keywords: | adult; aged; survival rate; major clinical study; lung lobectomy; cohort analysis; lung cancer; retrospective study; length of stay; symptom; disease severity; adverse outcome; total quality management; hospital patient; heart atrium arrhythmia; long term survival; prolonged length of stay |
| Journal Title: | Annals of Thoracic Surgery |
| Volume: | 94 |
| Issue: | 3 |
| ISSN: | 0003-4975 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2012-09-01 |
| Start Page: | 881 |
| End Page: | 888 |
| Language: | English |
| DOI: | 10.1016/j.athoracsur.2012.04.082 |
| PROVIDER: | scopus |
| PUBMED: | 22742847 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 October 2012" - "CODEN: ATHSA" - "Source: Scopus" |
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