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Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?

Publication ,  Journal Article
Speicher, PJ; Nussbaum, DP; Scarborough, JE; Zani, S; White, RR; Blazer, DG; Mantyh, CR; Tyler, DS; Clary, BM
Published in: HPB (Oxford)
December 2014

INTRODUCTION: The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated. METHODS: The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI. RESULTS: In total, 27,376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification. CONCLUSIONS: Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.

Duke Scholars

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

December 2014

Volume

16

Issue

12

Start / End Page

1068 / 1073

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Terminology as Topic
  • Surgical Wound Infection
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Quality Indicators, Health Care
  • Public Opinion
  • Practice Guidelines as Topic
 

Citation

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Speicher, P. J., Nussbaum, D. P., Scarborough, J. E., Zani, S., White, R. R., Blazer, D. G., … Clary, B. M. (2014). Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance? HPB (Oxford), 16(12), 1068–1073. https://doi.org/10.1111/hpb.12275
Speicher, Paul J., Daniel P. Nussbaum, John E. Scarborough, Sabino Zani, Rebekah R. White, Dan G. Blazer, Christopher R. Mantyh, Douglas S. Tyler, and Bryan M. Clary. “Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?HPB (Oxford) 16, no. 12 (December 2014): 1068–73. https://doi.org/10.1111/hpb.12275.
Speicher PJ, Nussbaum DP, Scarborough JE, Zani S, White RR, Blazer DG, et al. Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance? HPB (Oxford). 2014 Dec;16(12):1068–73.
Speicher, Paul J., et al. “Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?HPB (Oxford), vol. 16, no. 12, Dec. 2014, pp. 1068–73. Pubmed, doi:10.1111/hpb.12275.
Speicher PJ, Nussbaum DP, Scarborough JE, Zani S, White RR, Blazer DG, Mantyh CR, Tyler DS, Clary BM. Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance? HPB (Oxford). 2014 Dec;16(12):1068–1073.
Journal cover image

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

December 2014

Volume

16

Issue

12

Start / End Page

1068 / 1073

Location

England

Related Subject Headings

  • United States
  • Treatment Outcome
  • Terminology as Topic
  • Surgical Wound Infection
  • Surgery
  • Risk Factors
  • Risk Assessment
  • Quality Indicators, Health Care
  • Public Opinion
  • Practice Guidelines as Topic