Benchmarking in thoracic surgery
Por:
Freixinet, JL, Varela, G, Molins, L, Rivas, JJ, Rodriguez-Paniagua, JM, de Castro, PL, Izquierdo, JM and Torres, J
Publicada:
1 jul 2011
Resumen:
Objective: Presentation of an experience in benchmarking in 13 university Spanish thoracic surgery services. Methods: The minimum basic data set (MBDS) for hospitalization, corresponding to 2007, including all registered hospital discharges, was used. The performance of the hospitals was compared using an external reference pattern (SN) and internal average (BMG). Cases were chosen in which a major pulmonary resection (lobectomy or pneumonectomy) was done for bronchogenic carcinoma. Performance indicators were the complexity of the casuistry (average weight and relative weight). Performance results indicators included average length of stay (preoperative, postoperative, and global lengths of stay were analyzed separately for lobectomies as well as pneumonectomies), complications, mortality, and urgent readmissions. Results: A total number of 4778 cases were analyzed, with major thoracic surgeries being prominent with 1779 (37.3%). For average weight, there was a dispersion between 2.5 and 5.68, with an average of 3.45 for the BMG and 3.43 for the SN. There were some very significant differences in morbidity, with groups having a gross rate of few complications (2.6%) up to many (16.1%). The mortality rate ranged between 1.6% and 6.6%. There were considerable differences in urgent readmissions, with gross rates between 2.6% and 7.3%, considering as points of reference 5.4% (BMG) and 4.7% (SN). Concerning the results of pulmonary resections for bronchogenic carcinoma, the index of pneumonectomies was between 8% and 29%. The average length of stay for lobectomy was between 6 and 9.5, with an average of 7 in BMG. In the case of pneumonectomies, it was between 6 and 26 days, with an average of 9 for BMG. Average preoperative stay also varied widely, between 0.2 and 2.4, while postoperative stay was between 7.5 and 12.1. The gross global rate of complications ranged from 2.7% to 36.7%, with points of reference of 15.6% (BMG) and 13.8% (SN). The complication rate ranged from 3% to 33%, with an average of 14.5% for lobectomies, with higher variability for pneumonectomies (0-58%). Conclusions: Benchmarking could be an effective method for improving clinical management. A considerable variability was detected in our study among the participating groups. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Freixinet, JL:
Hosp Gran Canaria Dr Negrin, Thorac Surg Serv, Las Palmas Gran Canaria 35010, Spain
Varela, G:
Univ Hosp, Thorac Surg Serv, Salamanca, Spain
Molins, L:
Hosp Sagrado Corazon, Thorac Surg Serv, Barcelona, Spain
Rivas, JJ:
Hosp Miguel Servet, Thorac Surg Serv, Zaragoza, Spain
Rodriguez-Paniagua, JM:
Hosp Gen Univ, Thorac Surg Serv, Alicante, Spain
:
Hosp Badalona Germans Trias & Pujol, Thorac Surg Serv, Barcelona, Spain
Izquierdo, JM:
Hosp Donostia, Thorac Surg Serv, San Sebastian, Spain
Torres, J:
Hosp Virgen Arraixaca, Thorac Surg Serv, Murcia, Spain
Bronze
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