Citation

Halfon P, Eggli Y, Matter M, Kallay C, van Melle G, Burnand B. J. Clin. Epidemiol. 2007; 60(1): 56-67.

Affiliation

Institut Universitaire de Medecine Sociale et Preventive, University of Lausanne, 17 rue du Bugnon, 1005 Lausanne, Switzerland.

Copyright

(Copyright © 2007, Elsevier Publishing)

DOI

10.1016/j.jclinepi.2006.03.013

PMID

17161755

Abstract

OBJECTIVES: Reoperations may reflect a suboptimal initial surgical treatment. The study aimed to develop a screening algorithm for those potentially avoidable, using only routinely collected hospital data and a prediction model to adjust rates for case-mix. STUDY DESIGN AND SETTING: Data of a 3-year random sample of 7,370 therapeutic operations on inpatients, among which 833 were followed-up by a reoperation during the same stay. A review of medical records identified clearly avoidable and other potentially avoidable reoperations to develop and test the screening algorithm. A logistic prediction model of potentially avoidable reoperations was developed on one randomly chosen half of the data (about 9,000 interventions) and tested on the other half (cross-validation). RESULTS: Two hundred thirty-seven interventions (3%) were followed by a potentially avoidable reoperation, among which 144 were clearly avoidable. The screening algorithm had a sensitivity of 75% and a specificity of 72%. Predictors of potentially avoidable reoperations were surgery categories, diagnosis related conditions, and experiencing prior surgery. The risk score, based on these variables, showed at once a satisfactory discriminative performance (C-statistic=0.76) and goodness-of-fit measure on the validation set. CONCLUSION: The adjusted rate of potentially avoidable reoperations should be included in internal reporting of hospital quality indicators, but further validated in various settings.

Language: en