The HARM Score

Keller, Deborah S.; Chien, Hung Lun; Hashemi, Lobat; Senagore, Anthony J.; Delaney, Conor P.

doi:10.1097/sla.0b013e3182a6f45e

Cited by 24 publications

(15 citation statements)

References 39 publications

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“…Considering that both length of stay and readmission rate were lower in the robotic group, it is reasonable to suggest that this may be due to reduced surgical morbidity. This is supported by two recent studies published by the Cleveland clinic group who reported that length of stay, readmission rate and mortality effectively predict complications [ 52 , 53 ]. Considering that mortality was equal between the two groups in our study, these studies strengthen our argument that the reduced readmission rate and length of stay in the robotic cohort are due to a lower surgical morbidity profile.…”

Section: Discussionsupporting

confidence: 54%

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

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Abbas

et al. 2018

Int J Colorectal Dis

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PurposeLaparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients.MethodsAll consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined.ResultsA total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033).ConclusionsIn this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.

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Section: Discussionsupporting

confidence: 54%

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Panteleimonitis

Pickering

Abbas

et al. 2018

Int J Colorectal Dis

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“…The scores differ from other performance measures used to describe outcomes and quality of surgery and can be calculated using available administrative data, without the additional cost of software or ongoing costs for maintenance or personnel. As there is no investment cost, Keller et al [ 5 ] reported that the HARM score may decrease administrative costs associated with quality care improvement programs. Hence, the BAR-HARM score may be a good alternative to expensive programs like the MBSAQIP, which are used to measure outcomes in surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The categorical variables “discharge status” and “readmission” were defined as deceased/alive and yes/no, respectively. If the patient was deceased, the “readmission” variable was taken out of the equation, in accordance with the method described by Keller et al [ 5 ]. LOS was defined as the number of days from the date of initial bariatric or metabolic surgery to the date of hospital discharge and was categorized into the six categories as described in a previous study [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…If the patient was deceased, the “readmission” variable was taken out of the equation, in accordance with the method described by Keller et al [ 5 ]. LOS was defined as the number of days from the date of initial bariatric or metabolic surgery to the date of hospital discharge and was categorized into the six categories as described in a previous study [ 5 ]. Considering that the established LOS categories were defined on the basis of a normal distribution curve for colorectal surgery procedures, we decided to adjust the LOS categories to the distribution of LOS in the MBSQIP database for emergency and elective procedures separately (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Keller et al [ 5 ] identified the most important markers of surgical quality as hospital length of stay (LOS), readmission rates, and mortality rates; these variables were integrated into a simple, point-of-care metric referred to as the HospitAl stay, Readmission, and Mortality rates (HARM) score [ 5 ]. The HARM score was validated for measuring the quality of care in patients undergoing upper gastrointestinal (GI), hepatobiliary, and colorectal surgery [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients

et al. 2018

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BackgroundThe HospitAl stay, Readmission, and Mortality rates (HARM) score is a quality indicator that is easily determined from routine administrative data. However, the HARM score has not yet been applied to patients undergoing bariatric surgery.ObjectiveThe aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery.MethodsA MBSAQIP 2015 PUF database was reviewed. For each discharge, a 1 to 10 score was calculated on the basis of length of stay (LOS), discharge status, and 30-day readmissions. We adjusted the LOS categories to the distribution of LOS in the MBSQIP database. The new LOS categories were used to calculate the modified HARM score, referred to as the BARiatric HARM (BAR-HARM) score. The association between HARM and BAR-HARM scores and complication rate was assessed.ResultsA total of 197,141 cases were evaluated: 98.8% were elective and 1.2% were emergent admissions. The mean individual patient BAR-HARM score was 1.75 ± 1.04 for elective cases, and 2.02 ± 1.45 for emergency cases. The complication rates for the respective BAR-HARM categories ≤ 2, > 2 to 3, > 3 to 4, and > 4 were 3.95, 27.53, 40.14, and 79.97% (p < 0.001).ConclusionsThe quality of bariatric surgery can be reliably and validly assessed using the BAR-HARM score, which is a modification of the HARM score.Electronic supplementary materialThe online version of this article (10.1007/s11695-018-3253-5) contains supplementary material, which is available to authorized users.

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Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

2022

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ImportanceA textbook outcome (TO) is a composite quality measure that incorporates multiple perioperative events to reflect the most desirable outcome. The use of TO increases the event rate, captures more outcomes to reflect patient experience, and can be used as a benchmark for quality improvement.ObjectivesTo introduce the concept of TO to elective laparoscopic cholecystectomy (LC), propose the TO criteria, and identify characteristics associated with TO failure.Design, Setting, and ParticipantsThis retrospective cohort study was performed at 3 surgical units in a single health board in the United Kingdom. Participants included all patients undergoing elective LC between January 1, 2015, and January 1, 2020. Data were analyzed from January 1, 2015, to January 1, 2020.Main Outcomes and MeasuresThe TO criteria were defined based on review of existing TO metrics in the literature for other surgical procedures. A TO was defined as an unremarkable elective LC without conversion to open cholecystectomy, subtotal cholecystectomy, intraoperative complication, postoperative complications (Clavien-Dindo classification ≥2), postoperative imaging, postoperative intervention, prolonged length of stay (>2 days), readmission within 100 days, or mortality. The rate of TOs was reported. Reasons for TO failure were reported, and preoperative characteristics were compared between TO and TO failure groups using both univariate analysis and multivariable logistic regressions.ResultsA total of 2166 patients underwent elective LC (median age, 54 [range, 13-92] years; 1579 [72.9%] female). One thousand eight hundred fifty-one patients (85.5%) achieved a TO with an unremarkable perioperative course. Reasons for TO failure (315 patients [14.5%]) included conversion to open procedure (25 [7.9%]), subtotal cholecystectomy (59 [18.7%]), intraoperative complications (40 [12.7%]), postoperative complications (Clavien-Dindo classification ≥2; 92 [29.2%]), postoperative imaging (182 [57.8%]), postoperative intervention (57 [18.1%]), prolonged length of stay (>2 days; 142 [45.1%]), readmission (130 [41.3%]), and mortality (1 [0.3%]). Variables associated with TO failure included increasing American Society of Anesthesiologists score (odds ratio [OR], 2.55 [95 CI, 1.69-3.85]; P < .001), increasing number of prior biliary-related admissions (OR, 2.68 [95% CI, 1.36-5.27]; P = .004), acute cholecystitis (OR, 1.42 [95% CI, 1.08-1.85]; P = .01), preoperative endoscopic retrograde cholangiopancreatography (OR, 2.07 [95% CI, 1.46-2.92]; P < .001), and preoperative cholecystostomy (OR, 3.22 [95% CI, 1.54-6.76]; P = .002).Conclusions and RelevanceThese findings suggest that applying the concept of TO to elective LC provides a benchmark to identify suboptimal patterns of care and enables institutions to identify strategies for quality improvement.

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The HARM Score

Abstract: The HARM score is easy, reliable, and valid for assessing quality in colorectal surgery. It may provide a low-cost solution for comparative quality assessment in surgery focused on true outlier performance rather than process or clinical outcome metrics alone.

Cited by 24 publications

References 39 publications

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Robotic rectal cancer surgery in obese patients may lead to better short-term outcomes when compared to laparoscopy: a comparative propensity scored match study

Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients

Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

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