Dataset Information

Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients.

ABSTRACT: BACKGROUND:The HospitAl stay, Readmission, and Mortality rates (HARM) score is a quality indicator that is easily determined from routine administrative data. However, the HARM score has not yet been applied to patients undergoing bariatric surgery. OBJECTIVE:The aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery. METHODS:A MBSAQIP 2015 PUF database was reviewed. For each discharge, a 1 to 10 score was calculated on the basis of length of stay (LOS), discharge status, and 30-day readmissions. We adjusted the LOS categories to the distribution of LOS in the MBSQIP database. The new LOS categories were used to calculate the modified HARM score, referred to as the BARiatric HARM (BAR-HARM) score. The association between HARM and BAR-HARM scores and complication rate was assessed. RESULTS:A total of 197,141 cases were evaluated: 98.8% were elective and 1.2% were emergent admissions. The mean individual patient BAR-HARM score was 1.75?±?1.04 for elective cases, and 2.02?±?1.45 for emergency cases. The complication rates for the respective BAR-HARM categories ??2, >?2 to 3, >?3 to 4, and >?4 were 3.95, 27.53, 40.14, and 79.97% (p?

SUBMITTER: Janik MR

PROVIDER: S-EPMC6132742 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients.

Janik Michał R MR Mustafa Rami R RR Rogula Tomasz G TG Alhaj Saleh Adel A Abbas Mujjahid M Khaitan Leena L

Obesity surgery 20180901 9

<h4>Background</h4>The HospitAl stay, Readmission, and Mortality rates (HARM) score is a quality indicator that is easily determined from routine administrative data. However, the HARM score has not yet been applied to patients undergoing bariatric surgery.<h4>Objective</h4>The aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery.<h4>Me ...[more]

PMID: 29704230

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Project description:OBJECTIVE:Examine if adding aerobic exercise to standard medical care (EX+SC) prior to bariatric surgery improves metabolic health in relation to surgical outcomes. METHODS:Fourteen bariatric patients (age: 42.3±2.5y, BMI: 45.1±2.5 kg/m2) met inclusion criteria and were match-paired to pre-operative SC (n = 7) or EX+SC (n = 7; walking 30min/d, 5d/wk, 65-85% HRpeak) for 30d. A 120min mixed meal tolerance test was performed pre- and post-intervention (~2d prior to surgery) to assess insulin sensitivity (Matsuda Index) and metabolic flexibility (indirect calorimetry). Aerobic fitness (VO2peak), body composition (BodPod), and adipokines (adiponectin, leptin) were also measured. Omental adipose tissue was collected during surgery to quantify gene expression of adiponectin and leptin, and operating time and length of hospital stay were recorded. ANOVA and Cohen's d effect size (ES) was used to test group differences. RESULTS:SC tended to increase percent body fat (P = 0.06) after the intervention compared to EX+SC. Although SC and EX+SC tended to raise insulin sensitivity (P = 0.11), EX+SC enhanced metabolic flexibility (P = 0.01, ES = 1.55), reduced total adiponectin (P = 0.01, ES = 1.54) with no change in HMW adiponectin and decreased the length of hospital stay (P = 0.05) compared to SC. Albeit not statistically significant, EX+SC increased VO2peak 2.9% compared to a 5.9% decrease with SC (P = 0.24, ES = 0.91). This increased fitness correlated to shorter operating time (r = -0.57, P = 0.03) and length of stay (r = -0.58, P = 0.03). Less omental total adiponectin (r = 0.52, P = 0.09) and leptin (r = 0.58, P = 0.05) expression correlated with shorter operating time, and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01), and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01). CONCLUSION:Adding pre-operative aerobic exercise to standard care may improve surgical outcomes through a fitness and adipose tissue derived mechanism.

Project description:BackgroundUnder the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, hospitals will receive risk-adjusted outcomes feedback for peer comparisons and benchmarking. It remains uncertain whether bariatric outcomes have adequate reliability to identify outlying performance, especially for hospitals with low caseloads that will be included in the program. We explored the ability of risk-adjusted outcomes to identify outlying hospital performance with bariatric surgery for a range of hospital caseloads.Study designWe used the 2010 State Inpatient Databases for 12 states (N = 31,240 patients) to assess different outcomes (eg, complications, reoperation, and mortality) after bariatric stapling procedures. We first quantified outcomes reliability on a 0 (no reliability) to 1 (perfect reliability) scale. We then assessed whether risk- and reliability-adjusted outcomes could identify outlying performance among hospitals with different annual caseloads.ResultsOverall and serious complications had the highest overall reliability, but this was heavily dependent on caseload. For example, among hospitals with the lowest caseloads (mean 56 cases/year), reliability for overall complications was 0.49 and 6.0% of hospitals had outlying performance. For hospitals with the highest caseloads (mean 298 cases/year), reliability for overall complications was 0.79 and 30.3% of hospitals had outlying performance. Reoperation had adequate reliability for hospitals with caseloads higher than 120 cases/year. Mortality had unacceptably low reliability regardless of hospital caseloads.ConclusionsOverall complications and serious complications have adequate reliability for distinguishing outlying performance with bariatric surgery, even for hospitals with low annual caseloads. Rare outcomes, such as reoperations, have inadequate reliability to inform peer-based comparisons for hospitals with low annual caseloads, and mortality has unacceptably low reliability for bariatric performance profiling.

Dataset Information

Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients.

Publications

Application of HARM Score to Measure Surgical Quality and Outcomes in Bariatric Patients.

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