title: Variations in surgical outcomes associated with hospital compliance with safety practices.
abstract: BACKGROUND
  The Leapfrog Group aims to improve patient safety by promoting hospital compliance with National Quality Forum (NQF) safe practices. It is unknown, however, whether implementation of these safety practices improve outcomes after high-risk operations.
  
  
  METHODS
  We conducted a cross-sectional analysis of 658 nationwide hospitals that responded to the 2005 Leapfrog Group Hospital Quality & Safety survey. A total of 79,462 patients were identified from Medicare claims data who underwent a pancreatectomy, hepatectomy, esophagectomy, open aortic aneurysm repair, colectomy, or gastrectomy procedure from 2004 through 2006. Random effects logistic regression models were used to estimate the association between hospital compliance with NQF safe practices and risk-adjusted odds of complications, rate of failure to rescue, and mortality after adjusting for patient- and hospital-level confounders.
  
  
  RESULTS
  Of the 658 hospitals that responded to surveys, 41% had fully implemented NQF safe practices and 59% reported partial compliance with these standards. Compared with hospitals with partial NQF compliance, we found evidence that hospitals with full compliance had an increased likelihood of diagnosing a complication after any of the 6 high-risk operations (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.03-1.25), but had a decreased likelihood of failure to rescue (OR, 0.82; 95% CI, 0.71-0.96), and a decreased odds of mortality (OR, 0.80; 95% CI, 0.71-0.91).
  
  
  CONCLUSIONS
  Despite having a greater rate of postoperative complications, hospitals fully complying with safe practices were associated with less failure to rescue and decreased mortality after high-risk operations. These results highlight the importance of having hospital systems in place to promote safety and manage postoperative complications.
authors.affiliation: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Brooke@hitchcock.org
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: Francesca
authors.initials: F
authors.lastname: Dominici
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Eric
authors.initials: E
authors.lastname: Schneider
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States