Patient characteristics and the occurrence of never events.
OBJECTIVE
To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed.


METHODS
Epidemiological analysis.


METHODS
Derivation and assessment of predictive equations for postoperative infectious events and decubitus ulcers using Healthcare Cost and Utilization Project Nationwide Inpatient Sample administrative claims data for patients hospitalized between 2002 and 2005.


METHODS
C statistics for each predictive equation with and without hospital dummy variables.


RESULTS
Predictive equations for 6 of 8 complications had C statistics greater than 0.65 without hospital variables, while 2 had C statistics of less than 0.55. All equations had C statistics greater than 0.75 when hospital dummy variables were included.


CONCLUSIONS
Patient characteristics and type of operative procedure are important predictors of complications of surgical care evaluated in this study, undermining the rationale for their current classification as "never events." Variations in risk-adjusted complication rates among hospitals support the influence of quality of care on their occurrence. Development and use of warranties to cover costs associated with caring for the unavoidable components of potentially avoidable complications is proposed as a means of rewarding high-quality providers without creating unrealistic expectations or perverse financial incentives.
Michael Pine and Associates, 5020 S. Lake Shore Drive, Chicago, IL 60615, USA. dfry@consultmpa.com
Donald E
DE
Fry
Michael
M
Pine
Barbara L
BL
Jones
Roger J
RJ
Meimban
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors