Effects of minimally invasive colorectal surgery on PSI 90 across a five-hospital system

Document Type

Conference Proceeding

Publication Date

10-27-2021

Publication Title

Surg Endosc

Abstract

Introduction: The Agency for Healthcare Research and Quality use Patient Safety Indicators (PSI) to gauge patient safety at hospitals. PSI 90 is a weighted combination of several PSIs that are thought most impactful to perioperative patients. This score can affect reimbursement through Medicare and hospital rating. We sought to evaluate differences in PSI 90 occurrences across a five-hospital system for patients who underwent minimally invasive vs open colorectal operations. Methods: Using ICD-10 codes, a health system administrative database was queried across five participating hospitals for patients who underwent minimally invasive (laparoscopic or robotic) or open colorectal resection or excision surgery between 1/2/2018-12/31/2019. Common patient demographics and health information, along with case characteristics were analyzed with respect to surgical approach and the PSIs composing PSI 90. Statistical relationships between surgical approach and PSIs were investigated using univariate methods, and multivariate logarithmic regression analysis. PSIs of interest are those with the greatest weight in PSI 90: PSI 8 in hospital fracture/fall, PSI 9 perioperative hemorrhage, PSI 11 post-operative respiratory failure, PSI 12 perioperative venous thrombosis, and PSI 13 post-operative sepsis. Results: There were 1400 operations captured, with 860 (61%) being open and 540 (39%) being minimally invasive. Between the minimally invasive and open groups there was no statistically significant difference in regard to patient characteristics outside of biologic sex (1.36(1.00-1.84)(p = 0.048)), peripheral vascular disease (0.60(0.36-0.98)(p = 0.040)) and COPD (0.69(0.50-0.96)(p = 0.026)). MS-DRG diagnosis weight was higher for open operations (2.52, 2.43-2.91), compared to minimally invasive operations, (2.47, 1.69-2.52) (p < 0.001)). LACE score for open colorectal surgery was 16(4-19) and 17(15-18) for minimally invasive (p < 0.01). PSI 12 occurred in 1.1% of the open operations and 0% of the minimally invasive group (p = 0.015). PSI 11 occurred 0.9% in open operations and 0% of minimally invasive (p = 0.058). Other PSI incidences were not significant between the groups. Within the logistic models there were no statistically significant difference between the two groups created by surgical approach in respect to PSI 3, 6, or 8-15. Discussion: Understanding PSI 90 and its components are important to enhance perioperative patient care and optimize reimbursement for care provided. We demonstrate that minimally invasive operations, despite providing a known clinical benefit, may not impact scores in the PSI 90. Surgical approach may have little effect on PSI, and there may be other patient and system components that are more important to these outcome measures.

Volume

35

Issue

1

First Page

S51

Find It @ Sladen

Share

COinS