Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement.
Dr Kyle Sheetz and colleagues evaluated the variation in outcomes after ostomy creation surgery within Michigan to identify targets for quality improvement.
The team performed a retrospective cohort study.
The study took place within the 34-hospital Michigan Surgical Quality Collaborative.
Patients included were those undergoing ostomy creation surgery between 2006 and 2011.
The research team evaluated hospital morbidity and mortality rates after risk adjustment.
|Unadjusted morbidity rates were 44%|
|Diseases of the Colon & Rectum|
A total of 4250 patients underwent ostomy creation surgery.
The team observed that 91% of procedures were open, and 9% were laparoscopic.
The research team found that unadjusted morbidity and mortality rates were 44% and 11%.
Unadjusted morbidity rates for specific procedures ranged from 33% for ostomy-creation-only procedures to 48% for Hartmann procedures.
Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31% to 61%.
The researchers found that there were 5 statistically significant high-outlier hospitals, and 3 statistically significant low-outlier hospitals for risk-adjusted morbidity.
The pattern of complication types was similar between high- and low-outlier hospitals.
Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals.
Dr Sheetz's team concludes, "Morbidity and mortality rates for modern ostomy surgery are high."
"Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an opportunity to identify quality improvement practices that could be disseminated among hospitals."