title: Evaluating preventable adverse safety events after elective lower extremity procedures.
abstract: BACKGROUND
  Improving patient safety has become a national priority. Patient safety indicators (PSIs) are validated tools to identify potentially preventable adverse events. No studies currently exist for evaluating lower extremity (LE) vascular procedures and the occurrence of PSIs.
  
  
  METHODS
  The Nationwide Inpatient Sample (2003-2007) was queried for elective LE angioplasty (endo) and bypass (open). PSIs appropriate to surgery were analyzed by χ(2) and logistic regression analyses.
  
  
  RESULTS
  A total of 226,501 LE interventions (104,491 endo; 122,010 open) were evaluated. The rate of developing any PSI was 7.74% (open) and 8.51% (endo), P < .0001. In the latter group, PSI9 (postoperative hemorrhage or hematoma) with the rate 4.74% was a predominant indicator that was associated with an almost three times greater likelihood of death in this group. PSI predictors included advanced age (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.55-1.75 for oldest vs youngest patients), females (OR, 1.18; 95% CI, 1.13-1.22), blacks (OR, 1.10; 95% CI, 1.04-1.17), congestive heart failure (OR, 1.83; 95% CI, 1.72-1.96), diabetes mellitus (OR, 1.20; 95% CI, 1.12-1.28), renal failure (OR, 2.31; 95% CI, 2.14-2.50), hospital teaching status (OR, 1.21; 95% CI, 1.17-1.26), and larger hospitals (OR, 1.11; 95% CI, 1.05-1.17). PSI occurrence was associated with increased cost ($28,387 vs $13,278; P < .0001).
  
  
  CONCLUSIONS
  Endovascular procedures were found to have lower mortality rates overall, but were found to have a greater number of safety events occur primarily due to bleeding complications in women and the elderly. PSIs were associated with advanced age, black race, and comorbidities. Adverse events added significant cost, occurred more frequently in teaching and large hospitals, and future organizational analysis may improve safety and reduce cost.
authors.affiliation: UMDNJ-Robert Wood Johnson Medical School, Department of Surgery, Division of Vascular Surgery, The Surgical Outcomes Research Group, New Brunswick, NJ 08903-0019, USA. vogelto@umdnj.edu
authors.forename: Todd R
authors.initials: TR
authors.lastname: Vogel
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.forename: Paul B
authors.initials: PB
authors.lastname: Haser
authors.forename: Alan M
authors.initials: AM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000191:economics / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D058996:Quality Improvement / Q000191:economics / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D055815:Young Adult