title: Association between quality of care and complications after abdominal surgery.
abstract: BACKGROUND
  Measuring the quality of surgical care is essential to identifying areas of weakness in the delivery of effective surgical care and to improving patient outcomes. Our objectives were to (1) assess the quality of surgical care delivered to adult patients; and (2) determine the association between quality of surgical care and postoperative complications.
  
  
  METHODS
  This retrospective, pilot, cohort study was conducted at a single university-affiliated institution. Using the institution's National Surgical Quality Improvement Program database (2009-2010), 273 consecutive patients ≥18 years of age who underwent elective major abdominal operations were selected. Adherence to 10 process-based quality indicators (QIs) was measured and quantified by calculating a patient quality score (no. of QIs passed/no. of QIs eligible). A pass rate for each individual QI was also calculated. The association between quality of surgical care and postoperative complications was assessed using an incidence rate ratio, which was estimated from a Poisson regression.
  
  
  RESULTS
  The mean overall patient quality score was 67.2 ± 14.4% (range, 25-100%). The mean QI pass rate was 65.9 ± 26.1%, which varied widely from 9.6% (oral intake documentation) to 95.6% (prophylactic antibiotics). Poisson regression revealed that as the quality score increased, the incidence of postoperative complications decreased (incidence rate ratio, 0.19; P = .011). A sensitivity analysis revealed that this association was likely driven by the postoperative ambulation QI.
  
  
  CONCLUSIONS
  Higher quality scores, mainly driven by early ambulation, were associated with fewer postoperative complications. QIs with unacceptably low adherence were identified as targets for future quality improvement initiatives.
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: simon.bergman@mcgill.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Melina
authors.initials: M
authors.lastname: Deban
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Martelli
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Michèle
authors.initials: M
authors.lastname: Monette
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Sourial
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Fadi
authors.initials: F
authors.lastname: Hamadani
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Solidage-McGill University/Université de Montréal Research Group on Frailty and Aging, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Debby
authors.initials: D
authors.lastname: Teasdale
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Holcroft
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Helena
authors.initials: H
authors.lastname: Zakrzewski
authors.affiliation: Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Fraser
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care; D011792:Quebec; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards*