Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

Villodre, C.; Taccogna, L.; Zapater, Pedro; Canto, María Cristina Martínez; Mena, Luís; Ramia, José Manuel; Lluı́s, Fèlix; Afonso, Nuno; Aguilella, V.; Aguiló, Javier; Alados, Juan Carlos; Alberich, Marta; Apio, Ana Belén; Balongo, R.; Bra, E.; Bravo‐Gutiérrez, Alberto; Briceño, F. J.; Cabañas, Juana Ma Guzmán; Cánovas, Gloria; Caravaca, Ibán; Carbonell, Sílvia; Carrera-Dacosta, E.; Castro, Edgar; Caula, Celia; Choolani-Bhojwani, E.; Codina, Antonio Daponte; Corral, S.; Cuenca, Cantudo; Curbelo-Peña, Yuhamy; Delgado-Morales, M. M.; Delgado‐Plasencia, Luciano; Doménech, Estefanía; Estévez, A. M.; Feria, Alfredo; Gascón-Domínguez, M. A.; Moorjani, Rajesh Gianchandani; González, Cortiñas; Hevia, R. J.; González, M. A.; Hidalgo, José Manuel; Láinez, Miguel J. A.; Lluís, Núria; López, Francisca; López-Fernández, José; López-Ruiz, José; Lora-Cumplido, P; Madrazo, Zoilo; Marchena, Jose M.; Cuadra, Marenco B. de la; Martin, Shanique; Casas, Martínez I.; Martínez, Pablo; Mena-Mateos, A.; Morales-García, Dieter; Mulas, Claudia; Muñoz-Forner, E.; Naranjo, Andrea; Navarro‐Sánchez, Antonio; Oliver, Isabel; Ortega, Irene; Ortega-Higueruelo, R.; Ortega-Ruiz, S.; Osorio, Javier; Padín, M. H.; Pamies, J.; Paredes, María Celeste Gonzales; Pareja-Ciuró, Felipe; Parra, Judit; Pérez-Guarinos, Carmen Victoria; Pérez-Saborido, B.; Pintor‐Tortolero, José; Plua-Muniz, K.T.; Rey, Mónica Kateryn Vargas; Rodrı́guez, Ingrid; Ruiz, Cristina Ballesteros; Ruíz, R.; Ruiz, Sheila Picorelli; Sánchez, Antonio Rosino; Sánchez, Daniel Rodríguez; Sánchez, R Henche; Sánchez-Cabezudo, F.; Sánchez-Santos, Raquel; Santos, Julio Pascual; Serrano-Paz, M. P.; Soria-Aledo, Víctor; Tallón-Aguilar, Luis; Valdivia-Risco, J. H.; Vallverdú-Cartié, H.; Varela, Carlos Federico; Villar-del-Moral, Jesús; Zambudio, Natalia

doi:10.1016/j.ijsu.2021.106168

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…After initially reading the titles and abstracts, 166 full-text articles were identified for eligibility. Of these, 143 articles were excluded, and only 23 studies were included in qualitative assessment and synthesis after screening the full text 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 .…”

Section: Resultsmentioning

confidence: 99%

“…Outcome comparisons in surgery also include other clinically relevant outcome parameters such as readmission, length of stay, and comprehensive complication index (CCI) 12 13 14 . Currently, benchmarking targeting clinically relevant outcome measures for complex surgical procedures has become the focus in surgery 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 .…”

Section: Introductionmentioning

confidence: 99%

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Benchmarking: a novel measuring tool for outcome comparisons in surgery

Yuan

et al. 2023

International Journal of Surgery

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Introduction: Benchmarking, a novel measuring tool for outcome comparisons, is a recent concept in surgery. The objectives of this review are to examine the concept, definition, and evolution of benchmarking and its application in surgery. Methods: The literature about benchmarking was reviewed through an ever-narrowing search strategy, commencing from the concept, definition, and evolution of benchmarking to the application of benchmarking and experiences of benchmarking in surgery. PubMed, Web of Science, Embase, and Science Direct databases were searched until 20 September 2022, in the English language according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Results: In the first phase of the literature search, the development of benchmarking was identified. The definitions of benchmarking evolved from a surveying term to a novel quality-improvement tool to assess the best achievable results in surgery. In the second phase, a total of 23 studies were identified about benchmarking in surgery, including esophagectomy, hepatic surgery, pancreatic surgery, rectum resection, and bariatric surgery. All studies were multicenter analyses from national, international, or global expert centers. Most studies (87.0%) adopted the definition that benchmark was the 75th percentile of the median values of centers. Performance metrics to define benchmarks were clinically relevant intraoperative and postoperative outcome indicators. Conclusion: Benchmarking in surgery is a novel quality-improvement tool to define and measure the best achievable results, establishing a meaningful reference to evaluate surgical performance.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Benchmarking: a novel measuring tool for outcome comparisons in surgery

Yuan

et al. 2023

International Journal of Surgery

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“…Unfortunately, in Italy and other European countries, there is a lack of institutional emergency general surgery networks not allowing the implementation of benchmarking-based quality improvement programs [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

The burden of the knowledge-to-action gap in acute appendicitis

Cioffi,

Altomare,

Podda

et al. 2023

Surg Endosc

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Background The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance. Methods Data were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG. Results From 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%). Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units. Conclusions We confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.

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“…Preoperative variables included patient demographics, vital signs, and laboratory tests on admission. Postoperative events and clinical outcomes were recorded using the definitions of morbidity and complications set by POSSUM 27 . Local investigators collected centre-specific data using a secure online data-entry management system which accommodated smartphone, tablet, or desktop formats.…”

Section: Methodsmentioning

confidence: 99%

Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes

Lluís¹,

Carbonell²,

Villodre³

et al. 2023

International Journal of Surgery

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Background and aims: Previous studies indicated that laparoscopic surgery could improve postoperative outcomes in acute appendicitis, acute cholecystitis, perforated gastroduodenal ulcer, or acute diverticulitis, but some reported opposite results or differences in the magnitude of improvement. A contemporary analysis using propensity score matching that compares outcomes is lacking. Methods: Over a 6-month period, 38 centres (5% of all public hospitals) attending emergency general surgery patients on a 24 h, 7 days a week basis, enroled all consecutive adult patients who underwent laparoscopic surgery or open approach. Results: The study included 2 645 patients with acute appendicitis [32 years (22–51), 44.3% women], 1 182 with acute cholecystitis [65 years (48–76); 46.7% women], and 470 with gastrointestinal tract perforation [65 years (50–76); 34% women]. After propensity score matching, hospital stays decreased in acute appendicitis [open, 2 days (2–4); lap, 2 days (1–4); P<0.001], acute cholecystitis [open, 7 days (4–12); lap, 4 days (3–6); P<0.001], and gastrointestinal tract perforation [open, 11 days (7–17); lap, 6 days (5–8.5); P<0.001]. A decrease in 30-day morbidity was observed in acute appendicitis (open, 15.7%; lap, 9.7%; P<0.001), acute cholecystitis (open, 41%; lap, 21.7%; P<0.001), and gastrointestinal tract perforation (open, 45.2%; lap, 23.5%; P<0.001). A decrease in 30-day mortality was found in acute cholecystitis (open, 8.8%; lap, 2.8%; P=0.013) and gastrointestinal tract perforation (open, 10.4%; lap, 1.7%; P=0.013). Conclusions: This clinically based, multicentre study suggests that an initial laparoscopic approach could be considered not only in patients with acute appendicitis or acute cholecystitis but also in patients with a perforation of the gastrointestinal tract.

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Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

Cited by 7 publications

References 23 publications

Benchmarking: a novel measuring tool for outcome comparisons in surgery

Benchmarking: a novel measuring tool for outcome comparisons in surgery

The burden of the knowledge-to-action gap in acute appendicitis

Propensity score matching analysis of laparoscopic surgery vs. open approach in 4 297 adult patients with acute appendicitis, acute cholecystitis or gastrointestinal tract perforation: a prospective multicentre study of nationwide outcomes

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