Control charts to identify adverse outcomes in elective colon resection.
BACKGROUND
Control charts have been proposed for the measurement of quality in surgical care.


METHODS
For each of 181 study hospitals in the 2005 National Inpatient Sample of the Healthcare Cost and Utilization Project database, an average moving range control chart for risk-adjusted postoperative length of stay (RApoLOS) was created for patients discharged alive after elective colectomy. RApoLOS outliers using upper control limits of 2.0σ, 2.5σ, and 3.0σ were correlated to coded complications (CCs). Hospital costs were correlated to RApoLOS outliers and CCs.


RESULTS
Of 13,118 live discharges, 902 (6.9%) were outliers using a 3.0σ upper control limit, 1,350 (10.3%) were 2.5σ outliers, and 2,053 (15.7%) were 2.0σ outliers. CCs were identified in 92.7% of 3.0σ outliers, in 81.3% of 2.5σ outliers, and 70.6% of 2.0σ outliers. Increased costs were associated with RApoLOS outliers and poorly with CCs.


CONCLUSIONS
Average moving range control charts for RApoLOS outliers are valid tools for measurement of surgical quality and costs.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. dfry@consultmpa.com
Donald E
DE
Fry
Michael
M
Pine
Barbara L
BL
Jones
Roger J
RJ
Meimban
D003082:Colectomy / Q000191:economics / Q000592:standards*; D017558:Elective Surgical Procedures / Q000191:economics / Q000592:standards*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D020379:Risk Adjustment / Q000379:methods; D014481:United States