Comparison of Common Minimally Invasive Operations Using Patient Safety Indicators (PSI)
Stefanou A, Gardner CW, and Rubinfeld IS. Comparison of Common Minimally Invasive Operations Using Patient Safety Indicators (PSI). J Am Coll Surg 2021; 233(5):e98.
J Am Coll Surg
Introduction: The PSI 90, is used to monitor hospital safety, quality, and value. It is composed predominantly of PSI 9 (perioperative hemorrhage), 11 (postoperative respiratory failure), 12 (perioperative deep vein thrombosis/pulmonary embolus), and 13 (postoperative sepsis). MIS has been shown to have fewer complications. We aim to evaluate the rates of PSI between MIS in common procedures.
Methods: Using a health system database we examined cases that underwent MIS or open appendectomy, cholecystectomy, colectomy, and hysterectomy, and compared them across the four main PSIs over a 2-year period. Operations were compared based on comorbidities, admitting service and procedure. Outcome of interest was surgical approach. Univariate and multivariate analysis was performed in R.
Results: Our sample included a total of 1800 MIS and 1580 open operations. Rates of PSI were: PSI 9, 1.8%, PSI 11, 2.7%, PSI 12, 4.2%, and PSI 13, 5.6%. Patients were similar in comorbidities and demographics, with the exception of open procedures being more likely in cancer patients. Univariate analysis found no significant differences across surgical groupings of open vs MIS, or PSI type. Multivariate regression analysis did not show any significant association in MSI operative status and PSI incidence.
Conclusion: While minimally invasive surgery has known clinical benefits, this has not translated into a clear improvement across the AHRQ PSI. Additionally, there are still other modifiable factors that would allow for improvement of PSI 90 in minimally invasive surgery.