title: Plastic surgeon compliance with national safety initiatives: clinical outcomes and "never events".
abstract: BACKGROUND
  Venous thromboembolism and surgical-site infection have been identified as preventable complications that are addressed by the National Quality Forum and the Surgical Care Improvement Project. The authors examined compliance of faculty with venous thromboembolism and surgical-site infection prophylaxis and incidence of adverse outcomes in patients at risk.
  
  
  METHODS
  The authors performed retrospective chart reviews on 243 patients who underwent abdominoplasty or panniculectomy from 2000 to 2007 and documented demographics and adverse outcomes. Analysis was completed using Pearson's chi-square and Fisher's exact test for categorical variables. Significance was set at p < 0.05. Obesity was defined as body mass index more than 30 and morbid obesity was defined as body mass index more than 40.
  
  
  RESULTS
  Of 243 patients, 144 (59 percent) were obese. Seventeen patients (7 percent) suffered complications. All 243 patients received at least one form of venous thromboembolism prophylaxis. One patient had a deep venous thrombosis, and two had pulmonary embolism. These three patients were morbidly obese. Seventy-four percent of patients received appropriate antibiotics. Thirteen patients (5.3 percent) developed significant postoperative infection requiring hospitalization, 12 (92 percent) of whom received appropriate antibiotics. Eleven of these 13 patients (85 percent) were obese, and seven (54 percent) were morbidly obese. Obesity proved to be the only significant risk factor (p > 0.05).
  
  
  CONCLUSIONS
  Despite very good compliance with safe practice initiatives, significant adverse outcomes occurred. Obesity was the only pervasive risk factor. This study highlights the potential need for compliance with quality measures and demonstrates that adverse outcomes may result despite adherence to best surgical practices.
authors.affiliation: Allentown, Pa. From the Department of Surgery, Division of Plastic Surgery, Lehigh Valley Health Network.
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
authors.forename: Emily A
authors.initials: EA
authors.lastname: Peterson
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Adkinson
authors.forename: James F
authors.initials: JF
authors.lastname: Reed
mesh_terms: D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management / Q000592:standards*; D013518:Surgery, Plastic / Q000009:adverse effects* / Q000592:standards; D013530:Surgical Wound Infection / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate; D014481:United States; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*