Patient Safety: Postoperative Complications

Measure Title

Composite measure: Adult surgery patients with postoperative complications (postoperative pneumonia, catheter-associated urinary tract infection, or venous thromboembolic events).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

148 Percent surgical discharges with postoperative pneumonia events, catheter-associated urinary tract infection, or venous thromboembolic events, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with an adverse event of postoperative nosocomial pneumonia, urinary tract infection, or venous thromboembolic event (the sum of the percents of the three individual measures).

Comments

See entries for each of the components of the composite measure for further details about the methodology.

Measure Title

Adult surgery patients with postoperative pneumonia events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

149 Percent surgical discharges with postoperative pneumonia events, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with an adverse event of postoperative nosocomial pneumonia in patients who were not admitted with tracheostomies during the index hospitalization.

Comments

Postoperative nosocomial pneumonia is determined by evidence in the medical record of new infiltrate, consolidation, or cavitations noted on chest X-ray and documentation of physician diagnosis of postoperative pneumonia.

Measure Title

Adult surgery patients with catheter-associated urinary tract infection (UTI).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

150 Percent surgical discharges with catheter-associated urinary tract infection, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with a diagnosed postoperative urinary tract infection during the index hospital stay.

Comments

Diagnosed postoperative UTIs are defined as cases with one of the following:

• A physician diagnosis of UTI.
• Antibiotic treatment for UTI.
• A postoperative urine culture containing >105 organisms/cc of no more than two of the following pathogens: Escherichia coli, Enterococcus species, Klebsiella species, Pseudomonas species, Proteus species, Enterobacter species, Citrobacter species, fungi including Candida species and Staphylococcus aureus.

Measure Title

Adult surgery patients with postoperative venous thromboembolic events.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).

Table

151 Percent surgical discharges with postoperative venous thromboembolic events, United States, 2005

Data Source

CMS, MPSMS.

Denominator

All discharges from the MPSMS sample that had a surgical procedure in an operating room suite during the index hospital stay.

Numerator

Subset of the denominator with a diagnosed postoperative pulmonary embolus (PE) or deep vein thrombosis (DVT) during the index hospital stay (per medical record abstraction) or those who were readmitted to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9).

Comments

The measure specification has changed to include 30-day postoperative readmissions for pneumonia and venous thromboembolic events.

Venous thromboembolic events (VTE) include at least one of the following:

• Deep venous thromboses: Thromboses or occlusions within the venous system, most commonly of the lower extremities.
• Pulmonary emboli: Obstructions of the pulmonary artery vasculature (PE) usually arising from thrombi in the deep venous system of the lower extremities.

Diagnostic criteria for DVT include at least 1 of the following:

• Physician diagnosis of a DVT.
• An abnormal compression Duplex or Doppler ultrasonography, contrast venography, impedence plethysmography (IPG), or magnetic resonance venography (MR).

Diagnostic criteria for PE include a clinical index of suspicion and at least one of the following:

• High probability ventilation-perfusion (V/Q) scan.
• Moderate probability V/Q scan and abnormal duplex US of the lower extremities or lower extremity venogram.
• Abnormal helical (spiral) computerized tomographic (CT) exam of the pulmonary arteries indicating pulmonary embolus.
• Abnormal pulmonary angiography indicating pulmonary embolus.
• Abnormal magnetic resonance angiography (MR) exam of the pulmonary arteries indicating pulmonary embolus.

Measure Title

Composite measure: Adult Medicare patients having surgery who received appropriate timing of antibiotics (prophylactic antibiotics begun at the right time and ended at the right time).

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Table

152 Percent of adult surgery patients who received appropriate timing of antibiotics, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics within 1 hour prior to surgery and prophylactic antibiotics discontinued within 24 hours after surgery end time.

Comments

See entries for each of the components of the composite measure for further details about the methodology.

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Percent of adult Medicare patients having surgery who receive prophylactic antibiotics within 1 hour prior to surgical incision.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Table

153 Percent of adult surgery patients who received prophylactic antibiotics within 1 hour prior to surgical incision, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics within 1 hour prior to surgery.

Comments

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Percent of adult Medicare patients having surgery who have prophylactic antibiotics discontinued within 24 hours after surgery end time.

Measure Source

Centers for Medicare & Medicaid Services (CMS), Health Care Quality Improvement Program Quality Indicator.

Table

154 Percent of adult surgery patients who had prophylactic antibiotics discontinued within 24 hours after surgery end time, all payers, United States, 2005

Data Source

CMS, Medicare Quality Improvement Organizations Program (QIO).

Denominator

Medicare hospital discharges with indication of surgery.

Numerator

Subset of denominator who had prophylactic antibiotics discontinued within 24 hours after surgery end time.

Comments

This measure and its tables are also presented in other relevant sections of the report.

Measure Title

Postoperative septicemia per 1,000 elective-surgery discharges of 4 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

155 Postoperative sepsis per 1,000 elective-surgery discharges with an operating room procedure (excluding patients admitted for infection; patients with cancer or immunocompromised states; obstetric conditions; stays under 4 days; and admissions specifically), by

• Ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All elective hospital surgical discharges with length of stay of 4 or more days, excluding patients admitted for infection, patients with cancer or immunocompromised states, and obstetric conditions.

Numerator

Subset of the denominator with any secondary diagnosis of sepsis.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 13 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative hemorrhage or hematoma with surgical drainage or evacuation per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

156 Postoperative hemorrhage or hematoma with surgical drainage or evacuation, not verifiable as following surgery, per 1,000 surgical discharges (excluding obstetrical admissions), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Inpatient hospital surgical discharges, excluding obstetrical admissions.

Numerator

Subset of the denominator meeting the following criteria:

1. Secondary diagnosis indicating postoperative hemorrhage or postoperative hematoma.
2. Secondary procedure indicating postoperative control of hemorrhage or drainage of hematoma.

Comments

Procedure code for postoperative control of hemorrhage or hematoma not verified as following surgery.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 9 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative pulmonary embolus (PE) or deep vein thrombosis (DVT) per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

157 Postoperative pulmonary embolus or deep vein thrombosis (DVT) per 1,000 surgical discharges (excluding patients admitted for DVT, obstetrics, and plication of vena cava before or after surgery), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Hospital surgical patients, excluding patients admitted for deep vein thrombosis, obstetrics, neonatal, and plication of vena cava before or after surgery.

Numerator

Subset of the denominator with any secondary diagnosis of deep vein thrombosis or pulmonary embolism.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 12 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative respiratory failure per 1,000 elective-surgery discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

158 Postoperative respiratory failure per 1,000 elective-surgery discharges with an operating room procedure (excluding patients with respiratory disease, circulatory disease, neuromuscular disorders, obstetric conditions, and admissions specifically for acute respiratory failure), age 18 years and older, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All elective hospital surgical discharges, excluding patients with respiratory disease, circulatory disease, and obstetric conditions.

Numerator

Subset of the denominator with any secondary diagnosis of acute respiratory failure (ICD-9-CM diagnosis codes 518.81 and 518.84).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 11 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative physiologic and metabolic derangements per 1,000 elective-surgery patients.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

159 Postoperative physiologic and metabolic derangements per 1,000 elective-surgery discharges (excluding some serious disease and obstetric admissions), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All elective hospital surgical discharges, excluding some serious disease (i.e., patients with diabetic coma; patients with renal failure who were admitted for acute myocardial infarction, cardiac arrhythmia, cardiac arrest, shock, hemorrhage, or gastrointestinal hemorrhage) and obstetric admissions.

Numerator

Subset of the denominator with any secondary diagnosis indicating physiologic and metabolic derangements.

Comments

Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure for dialysis.

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 10 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative hip fractures per 1,000 surgical discharges age 18 years and over.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

160 Postoperative hip fracture for adults per 1,000 surgical patients age 18 and over who were not susceptible to falling (excluding obstetrical admissions), United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Inpatient hospital surgical discharges age 18 and over who were not susceptible to falling (i.e., excluding patients with musculoskeletal disease; those admitted for seizures, syncope, stroke, coma, cardiac arrest, poisoning, trauma, delirium, psychoses, anoxic brain injury; patients with metastatic cancer, lymphoid malignancy, bone malignancy, and self-inflicted injury).

Numerator

Subset of the denominator with any secondary diagnosis indicating hip fracture.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 8 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Postoperative abdominal wound dehiscence per 1,000 relevant discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

161 Reclosure of postoperative abdominal wound dehiscence per 1,000 abdominopelvic-surgery discharges (excluding immunocompromised patients, stays under 2 days, and obstetric conditions), age 18 and over, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

Inpatient hospital abdominopelvic-surgery discharges, excluding obstetric conditions.

Numerator

Non-maternal/non-neonatal abdominopelvic-surgery discharges with secondary procedure for reclosure of postoperative disruption of abdominal wall (ICD-9-CM procedure code 54.61).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 14 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Foreign body left in body during procedure per 1,000 discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

162 Foreign body accidentally left in during procedure per 1,000 medical and surgical discharges, age 18 and over or obstetric admissions, United States, 2004, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All non-neonatal medical and surgical inpatient hospital discharges.

Numerator

Non-neonatal medical and surgical discharges with any secondary diagnosis indicating foreign body left in during procedure.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 5 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Complications of anesthesia per 1,000 surgical discharges.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

163 Complications of anesthesia in any secondary diagnosis per 1,000 surgical discharges (excluding patients with anesthesia complications as a principal diagnosis and patients with self-inflicted injury, poisoning due to anesthetics, and active drug dependence), age 18 and over or obstetric admissions, by:

• Ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All surgical hospital discharges, excluding patients with active drug dependence, active nondependent abuse of drugs, and self-inflicted injury.

Numerator

Subset of the denominator with any secondary diagnosis indicating anesthesia complications.

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 1 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.

Measure Title

Decubitus ulcers per 1,000 discharges of length 5 or more days.

Measure Source

Agency for Healthcare Research and Quality (AHRQ), Patient Safety Indicators (PSI).

Table

164 Decubitus ulcers per 1,000 discharges of length 5 or more days (excluding transfers; patients admitted from long-term care facilities; patients with diseases of the skin, subcutaneous tissue, and breast; and obstetrical admissions), age 18 and over, by

• Race/ethnicity.

Data Source

AHRQ, Center for Delivery, Organization, and Markets (CDOM), Healthcare Cost and Utilization Project (HCUP).

Denominator

All non-maternal medical and surgical hospital discharges with length of stay of 5 or more days, excluding paralysis patients, patients admitted from long-term care facilities, and patients with diseases of the skin, subcutaneous tissue, and breast.

Numerator

Subset of the denominator with any secondary diagnosis of decubitus ulcer (ICD-9-CM diagnosis code 707.0).

Comments

Rates are adjusted by age, gender, age-gender interactions, comorbidities, and Diagnosis Related Group (DRG) clusters. When reporting is by age, the adjustment is by gender, comorbidities, and DRG clusters; when reporting is by gender, the adjustment is by age, comorbidities, and DRG clusters.

The disparities analysis file, created specifically for this report to provide national estimates on disparities, consists of weighted records from a sample of hospitals from the following 23 States that participate in HCUP and have high-quality race/ethnicity data: AZ, AR, CA, CO, CT, FL, GA, HI, KS, MD, MA, MI, MO, NH, NJ, NY, RI, SC, TN, TX, VA, VT, and WI.

This table was created using version 2.1, revision 2, of the AHRQ Patient Safety Indicators software. This measure is referred to as indicator 3 in the AHRQ Patient Safety Indicators software documentation. More information about the AHRQ Quality Indicators is available at http://www.qualityindicators.ahrq.gov.