Detecting accidental punctures and lacerations during cholecystectomy in large datasets: Two methods of analysis

摘要

Background: After the Institute of Medicine (IOM) report To Err Is Human highlighted the impact of med-ical errors, the Agency for Healthcare Research and Quality (AHRQ) developed Patient-Safety Indicators (PSI) to improve quality by identifying potential inpatient safety problems. PSI-15 was created to study accidental punctures and lacerations (APL), but PSI-15 may underestimate APLs in populations of patients. This study compares PSI-15 with a more inclusive approach using a novel composite of secondary diag-nostic and procedural codes. Methods: We used Nationwide Inpatient Sample (NIS) data (2000–2012) from AHRQ's Healthcare Cost and Utilization Project (H-CUP). We analyzed PSI-15-positive and -negative cholecystectomies. Cross tab-ulations identified codes that were significantly more frequent among PSI-15-positive cases; these sec-ondary diagnostic and procedural codes were selected as candidate members of a composite marker (CM) of APL. We chose cholecystectomy patients for study because this is one of the most common general op-erations, and the large size of NIS allows for meaningful analysis of infrequent occurrences such as APL rates. Results: CM identified 1.13 times more APLs than did PSI-15. Patients with CM-detected APLs were sig-nificantly older and had worse mortality, comorbidities, lengths of stay, and charges than those detected with PSI-15. Further comparison of these two approaches revealed that time-series analysis for both APL markers revealed parallel trends, with inflections in 2007, and lowest APL rates in July. Conclusions: Although CM may yield more false positives, it appears more inclusive, identifying more clinically significant APLs, than PSI-15. Both measures presented similar trends over time, arguing against inflation in PSI-15 reporting. While arguably less specific, CM may increase sensitivity for detecting APL events during cholecystectomies. These results may inform the interpretation of other large population studies of APLs following abdominal operations.