Statewide Clinic Registries: The Michigan Surgical Quality Collaborative

Nikolian, Vahagn C.; Regenbogen, Scott E.

doi:10.1055/s-0038-1673350

Cited by 20 publications

(11 citation statements)

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“…This approach has been previously used to identify robotic procedures in claims data . To evaluate the precision of these codes for identification of robotic surgery, we compared annual rates of robotic colectomy for all Medicare beneficiaries to those from a validated statewide clinical registry for surgical care in the state of Michigan, the Michigan Surgical Quality Collaborative . Data in this registry were manually abstracted by trained nurses and audited for accuracy.…”

Section: Methodsmentioning

confidence: 99%

“…10 To evaluate the precision of these codes for identification of robotic surgery, we compared annual rates of robotic colectomy for all Medicare beneficiaries to those from a validated statewide clinical registry for surgical care in the state of Michigan, the Michigan Surgical Quality Collaborative. 11 Data in this registry were manually abstracted by trained nurses and audited for accuracy. Results from the claims data (national and Michigan-only cohorts) were similar to what was derived from the clinical registry (eAppendix in the Supplement).…”

Section: Data Source and Study Populationmentioning

confidence: 99%

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Perioperative Outcomes and Trends in the Use of Robotic Colectomy for Medicare Beneficiaries From 2010 Through 2016

et al. 2020

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IMPORTANCE The use of robotic surgery for common operations like colectomy is increasing rapidly in the United States, but evidence for its effectiveness is limited and may not reflect real-world practice. OBJECTIVE To evaluate outcomes of and trends in the use of robotic, laparoscopic, and open colectomy across diverse practice settings. DESIGN, SETTING, AND PARTICIPANTS This population-based study of Medicare beneficiaries undergoing elective colectomy was conducted between January 2010 and December 2016. We used an instrumental variable analysis to account for both measured and unmeasured differences in patient characteristics between robotic, open, and laparoscopic colectomy procedures. Data were analyzed from January 21, 2019, to March 1, 2019. EXPOSURES Receipt of robotic colectomy. MAIN OUTCOMES AND MEASURES Incidence of postoperative medical and surgical complications and length of stay. RESULTS A total of 191 292 procedures (23 022 robotic procedures [12.0%], 87 639 open procedures [45.8%], and 80 631 laparoscopic colectomy procedures [42.0%]) were included. Robotic colectomy was associated with a lower adjusted rate of overall complications than open colectomy (17.6% [95% CI, 16.9%-18.2%] vs 18.6% [95% CI, 18.4%-18.7%]; relative risk [RR], 0.94 [95% CI, 0.91-0.98]). This difference was driven by lower rates of medical complications (15.5% [95% CI, 14.8%-16.2%] vs 16.9% [95% CI, 16.7%-17.1%]; RR, 0.92 [95% CI, 0.87-0.96]) because surgical complications were higher with the robotic approach (3.0% [95% CI, 2.8%-3.2%] vs 2.4% [95% CI, 2.3%-2.5%]; RR, 1.18 [95% CI, 1.04-1.35]). There were no differences in complications between robotic and laparoscopic colectomy (11.1% [95% CI, 10.5%-11.6%] vs 11.0% [95% CI, 10.8%-11.2%]; RR, 1.00 [95% CI, 0.95-1.05]). There was an overall shift toward greater proportional use of robotic colectomy from 0.7% (457 of 65 332 patients) in 2010 to 10.9% (8274 of 75 909 patients) in 2016. In hospitals with the highest adoption of robotic colectomy between 2010 and 2016, increasing use of robotic colectomy (0.8% [100 of 12 522 patients] to 32.8% [5416 of 16 511 patients]) was associated with a greater replacement of laparoscopic operations (43.8% [5485 of 12 522 patients] to 25.2% [4161 of 16 511 patients]) than open operations (55.4% [6937 of 12 522 patients] to 41.9% [6918 of 16 511 patients]). CONCLUSIONS AND RELEVANCE While robotic colectomy was associated with minimal safety benefit over open colectomy and had comparable outcomes with laparoscopic colectomy, population-based trends suggest that it replaced a greater proportion of laparoscopic rather than open colectomy, especially in hospitals with the highest adoption of robotics.

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Section: Methodsmentioning

confidence: 99%

Section: Data Source and Study Populationmentioning

confidence: 99%

Perioperative Outcomes and Trends in the Use of Robotic Colectomy for Medicare Beneficiaries From 2010 Through 2016

et al. 2020

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“…10 The MSQC maintains a registry of prospectively collected data on patients undergoing surgery that includes patient demographic characteristics, perioperative processes, and 30-day outcomes. 20 Data are abstracted by trained Surgical Clinical Quality Reviewers (SCQR) who have access to patients' entire medical records. Assurance of data integrity involves regular interrater reliability assessments, annual auditing of data accuracy, and reviewing all cases using a sampling algorithm that is designed to minimize selection bias.…”

Section: Data Source and Patient Populationmentioning

confidence: 99%

Heterogeneity in Surgical Quality Improvement in Michigan

et al. 2021

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The aim of this study was to evaluate changes in 30-day postoperative outcomes and individual hospital variation in outcomes from 2012 to 2019 in a collaborative quality improvement network. Summary Background Data: Collaborative quality improvement efforts have been shown to improve postoperative outcomes overall; however, heterogeneity in improvement between participating hospitals remains unclear. Understanding the distribution of individual hospital-level changes is necessary to inform resource allocation and policy design. Methods: We performed a retrospective cohort study of 51 hospitals in the Michigan Surgical Quality Collaborative (MSQC) from 2012 to 2019. Risk-and reliability-adjusted hospital rates of 30-day mortality, complications, serious complications, emergency department (ED) visits, readmissions, and reoperations were calculated for each year and compared between the last 2 years and the first 2 years of the study period.Results: There was a significant decrease in the rates of all 5 adverse outcomes across MSQC hospitals from 2012 to 2019. Of the 51 individual hospitals, 31 (61%) hospitals achieved a decrease in mortality (range -1.3 percentage points to +0.6 percentage points), 40 (78%) achieved a decrease in complications (range -8.5 percentage points to +2.9 percentage points), 26 (51%) achieved a decrease in serious complications (range -3.2 percentage points to +3.0 percentage points), 29 (57%) achieved a decrease in ED visits (range 5.0 percentage points to +2.2 percentage points), 46 (90%) achieved a decrease in readmissions (range -3.1 percentage points to +0.4 percentage points) and 39 (76%) achieved a decrease in reoperations (range 3.3 percentage points to +1.0 percentage points). Conclusions: Despite overall improvement in surgical outcomes across hospitals participating in a quality improvement collaborative, there was substantial variation in improvement between hospitals, highlighting opportunities to better understand hospital-level barriers and facilitators to surgical quality improvement.

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“…The registry prospectively collects data on perioperative processes of care and 30-day clinical outcomes after operations performed at the participating hospitals. Data are reviewed and abstracted by trained data abstractors and a sampling algorithm is used to minimize selection bias [19]. In January 2020, the MSQC variable database was expanded to capture hernia-specific intraoperative variables such as hernia location, recurrence and size (Table 1).…”

Section: Study Populationmentioning

confidence: 99%

Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details

et al. 2021

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Background Variable approaches to intraoperative communication impede our understanding of surgical decision-making and best practices. This is critical among hernia repairs, where improved outcomes are reliant on understanding the impact of different patient characteristics and surgical approaches. In this context, a hernia-specific synoptic operative note was piloted as part of an effort to create a statewide hernia registry. We aimed to understand the impact of the synoptic operative note on variable missingness and evaluate barriers and facilitators to improved intraoperative communication and note adoption. Methods In January 2020, the Michigan Surgical Quality Collaborative (MSQC) registry was expanded to capture herniaspecific intraoperative variables. A synoptic operative note for hernia repair was piloted at 8 hospitals. The primary outcome was change in hernia variable communication, measured by missingness. Using a sequential explanatory mixed-methods design, we performed semi-structured interviews with data abstractors (n = 4) and surgeons (n = 4) at 5 pilot sites to assess barriers and facilitators of implementation. Interviews were iteratively analyzed using content analysis with both deductive and inductive approaches. Results From January to June 2020, 870 hernia repairs were performed across 8 pilot and 53 control sites. Pilot sites had significantly less missingness for all hernia-specific variables. At pilot sites, 46% of notes were fully complete in regard to hernia variables, compared to 21% at control sites (p value < 0.001). While collection of intraoperative variables improved after synoptic note implementation, low note adoption was reported. Facilitators of improved variable collection were (1) communication with data abstractors and (2) stakeholder acknowledgment of widespread benefit, while barriers included (1) surgeon resistance to practice change, (2) EMR/technology, and (3) interruptions to communication and implementation. Conclusion This mixed-methods evaluation of a synoptic operative note implementation suggests that sustained communication, particularly with abstractors, was the most impactful intervention. Future implementation efforts may have improved effectiveness with interventions supplementary to surgeon-level direction.

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Statewide Clinic Registries: The Michigan Surgical Quality Collaborative

Cited by 20 publications

References 50 publications

Perioperative Outcomes and Trends in the Use of Robotic Colectomy for Medicare Beneficiaries From 2010 Through 2016

Perioperative Outcomes and Trends in the Use of Robotic Colectomy for Medicare Beneficiaries From 2010 Through 2016

Heterogeneity in Surgical Quality Improvement in Michigan

Implementation of a synoptic operative note for abdominal wall hernia repair: a statewide pilot evaluating completeness and communication of intraoperative details

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