Establishing standard hospital performance measures for cervical spinal trauma: a Nationwide In-patient Sample study.
METHODS
A retrospective national administrative database study.


OBJECTIVE
Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are metrics for quality of health care and are linked to reimbursement. The prevalence of PSIs/HACs may impact access to health care for certain conditions. We estimated the national occurrence rates of PSIs/HACs among cervical trauma patients and identified patient factors that correlate with their occurrence.


METHODS
United States of America.


METHODS
We queried Nationwide In-patient Sample database (NIS) hospitalizations (2002-2010) for diagnoses of cervical fracture with and without spinal cord injury (SCI). The incidence of each PSI/HAC was determined by ICD-9 (International Classification of Disease, 9th Revision) codes. Multivariate analysis was used to identify the correlation between specific variables and the probability of each indicator.


RESULTS
There were 52,377 hospitalizations for cervical fracture in the NIS (without SCI, n = 41,708; with SCI, n = 10,669). Among those without SCI, there were 5374 (12.9%) reported PSIs and 117 (0.3%) HACs. Leading adverse events were postoperative respiratory failure (8.45%), pulmonary embolism (1.70%) and pressure ulcer (1.12%). Among those with SCI, there were 6600 (61.9%) PSIs and 143 (1.3%) HACs. Leading adverse events were postoperative respiratory failure (39.2%), pressure ulcer (7.78%), sepsis (5.71%), deep venous thrombosis (3.81%) and PE (1.70%). Adverse events were associated with several factors, including age, gender, Comorbidity Score and Injury Severity Score. Those with ⩾ 1 PSI/HAC had significantly longer lengths of stay (P < 0.0001) and higher hospital costs (P < 0.0001) and mortality (P < 0.0001) compared with patients without events.


CONCLUSIONS
These results estimate baseline national rates of PSIs/HACs in patients with cervical spine trauma. These data may be used to gauge individual institutional quality of care in comparison with national data.
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
D J
DJ
Hoh
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
M
M
Rahman
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
K M
KM
Fargen
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
D
D
Neal
Department of Neurosurgery, University of Florida, Gainesville, FL, USA.
B L
BL
Hoh
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics* / Q000453:epidemiology; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000191:economics / Q000592:standards*; D012189:Retrospective Studies; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D014481:United States