TY - JOUR
T1 - Impact of Facility Volume on Patient Safety Indicator Events After Transsphenoidal Pituitary Surgery
AU - Lemdani, Mehdi S.
AU - Choudhry, Hannaan S.
AU - Tseng, Christopher C.
AU - Fang, Christina H.
AU - Sukyte-Raube, Donata
AU - Patel, Prayag
AU - Eloy, Jean Anderson
N1 - Publisher Copyright:
© 2023 American Academy of Otolaryngology–Head and Neck Surgery Foundation.
PY - 2023/2
Y1 - 2023/2
N2 - Objectives: To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design: Retrospective database review. Setting: National Inpatient Sample database (2003-2011). Methods: The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results: An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P <.001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P <.001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P <.001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P <.001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P <.001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P <.001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P <.001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P <.001). Conclusion: PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
AB - Objectives: To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design: Retrospective database review. Setting: National Inpatient Sample database (2003-2011). Methods: The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results: An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P <.001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P <.001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P <.001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P <.001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P <.001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P <.001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P <.001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P <.001). Conclusion: PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
KW - National Inpatient Sample
KW - Patient Safety Indicator
KW - never events
KW - postoperative outcomes
KW - transsphenoidal pituitary surgery
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U2 - 10.1177/01945998221089826
DO - 10.1177/01945998221089826
M3 - Article
C2 - 35380889
AN - SCOPUS:85129159075
SN - 0194-5998
VL - 168
SP - 227
EP - 233
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 2
ER -