title: Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.
abstract: BACKGROUND
  Pancreatic surgery outcomes vary widely. We hypothesize that by comparing high and low mortality hospitals, we may identify differences in patient care impacting safety.
  
  
  METHODS
  We sampled hospitals with very-low and very-high mortality (LMH; HMH) and conducted on-site chart reviews evaluating perioperative care practices for pancreatic operations.
  
  
  RESULTS
  HMHs had an 11.6% mortality rate; LMHs 1.5%. Patients in HMHs had worse ASA classification (20.9% ASA Class 4/5 vs. 2.0%, P < 0.001) and comorbidity burden (55.3% with ≥ 1 comorbidity vs. 39.6%, P = 0.037). At HMHs, operations took longer (353.9 min vs. 313.7 min, P = 0.05), had higher blood loss (1,203.7 ml vs. 881.6 ml, P = 0.04), and patients underwent more transfusions (70.2% vs. 41.1%, P < 0.001). There were differences in anesthetic care: less invasive monitoring (76.1% vs. 93.1%, P < 0.001) and epidural pain management (22.5% vs. 62.9%, P < 0.001). Both cohorts had similar rates of VTE prophylaxis and SSI prevention compliance.
  
  
  CONCLUSIONS
  High and low mortality hospitals both have high compliance with common quality measures; however, HMHs performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts.
authors.affiliation: Department of Surgery, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.affiliation: Department of Surgery, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
authors.forename: Huiying
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Surgery, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
authors.affiliation: Department of Surgery, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D019990:Perioperative Care; D058996:Quality Improvement; D012189:Retrospective Studies
keywords: inpatients/statistics and numerical data; neoplasms/surgery; outcome and process assessment; perioperative care; quality improvement/trends; quality of healthcare