The identification of health care institutions with outlying outcomes is of great importance for reporting health care results and for quality improvement.
Historically, elective surgical outcomes have received greater attention than nonelective results, although some studies have examined both.
Differences in outlier identification between these patient groups have not been adequately explored.
Dr Ben Byrne and colleagues compared the identification of institutional outliers for mortality after elective, and nonelective colorectal resection in England.
The research team performed a cohort study using routine administrative data.
The team determined 90-day mortality by using statutory records of death.
|90-day mortality rates after elective and nonelective surgery were 4% and 18%|
|Diseases of the Colon & Rectum|
Adjusted Trust-level mortality rates were calculated by using multiple logistic regression.
The researchers identified high and low mortality outliers and compared across funnel plots for elective and nonelective surgery.
All English National Health Service Trusts providing colorectal surgery to an unrestricted patient population were studied.
The team included adults admitted for colorectal surgery between 2006 and 2012.
Segmental colonic or rectal resection was performed.
The team's primary outcome measured was 90-day mortality.
Included were 195,118 patients, treated at 147 Trusts.
The research team found that 90-day mortality rates after elective and nonelective surgery were 4% and 18%.
No unit with high outlying mortality for elective surgery was a high outlier for nonelective mortality and vice versa.
Trust level, observed-to-expected mortality for elective and nonelective surgery, was moderately correlated.
Dr Byrne's team concludes, "Status as an institutional mortality outlier after elective and nonelective colorectal surgery was not closely related."
"Therefore, mortality rates should be reported for both patient cohorts separately."
"This would provide a broad picture of the state of colorectal services and help direct research and quality improvement activities."