Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases

Dierks, Meghan M.; Huang, Zhen S.; Siracuse, Jeffrey J.; Tolchin, Simona; Moorman, Donald W.

doi:10.1016/j.amjsurg.2009.09.020

« Previous Next »The American Journal of Surgery
Volume 199, Issue 3 , Pages 324-330, March 2010

Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases

Meghan M. Dierks, M.D.
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
Zhen S. Huang, M.D.
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
Jeffrey J. Siracuse, M.D.
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
Simona Tolchin
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA
Donald W. Moorman, M.D.
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Surgery, WPAHS, Allegheny General Hospital, North Ave, 5th Fl, Pittsburgh, PA 15212, USA
- Corresponding author: Tel.: +1-412-359-4159; fax: +1-412-359-3165

Received 1 August 2009; received in revised form 18 September 2009

Abstract

Background

Underreporting of surgical adverse events limits the ability to identify quality and safety issues. Automated screening of the clinical information system (CIS) can improve case capture and reduce dependency on self-reporting. We compared screening of a CIS to self-reporting for identifying unplanned reoperation and also examined the relationship between causality and probability of reporting.

Methods

Between 2005 and 2009, all unplanned reoperations identified by automated screening of databases were reviewed and classified according to causality. Comparison was made to cases self-reported to departmental morbidity and mortality; conditional probability analysis assessed the likelihood of reporting as a function of causality.

Results

Of 104,938 operations performed, automated CIS screening identified 1,010 cases requiring unplanned reoperation; 23.6% were self-reported to morbidity and mortality; the probability of reporting varied widely depending on causality.

Conclusions

Screening of a CIS for adverse events requiring reoperation revealed significant underreporting, with additional bias in reporting based on underlying causality.

Keywords: Outcomes, Reporting, Return to operating room, Morbidity and mortality, Barriers to reporting, Underreporting