A Study of Adverse Occurrences and Major Functional Impairment Following Surgery
Abstract
Objective: The authors sought to ascertain whether adverse occurrences (AOs) are associated with functional impairment changes among surgical patients. Methods: A case-control study was conducted with blinded, retrospective chart review of prevalent surgical procedures from a New York State Medicare database. Surgical AO cases were randomly selected from the 1998 2001 New York Patient Occurrence and Reporting System (NYPORTS) database. Non- NYPORTS controls were matched for surgery type, hospital, and procedure date. Functional status was assessed before surgery and at discharge using the Modified Rankin Scale. Logistic regression was used to examine the relationship between AOs and Rankin scores. Results: Nurses reviewed 1,545 records of surviving patients from 15 surgical procedure categories, of whom 1,211 were categorized as having low functional impairment and 334 as having high functional impairment before surgery. After adjusting for presurgery functional status, age, gender, and perioperative risk, there was a 2.3 odds ratio (95 percent confidence interval = 1.7 3.1) that a surgical patient experiencing an AO would change from low to high functional impairment. Among the patients with high presurgery functional impairment, equivalent numbers were discharged with high impairment, regardless of AO status. Overall, the median length of stay was 11 days for patients experiencing an adverse occurrence and 6 days for patients who did not (P < 0.001). Conclusions: Medicare beneficiaries with minimal functional impairment before surgery were more likely to have major functional impairment at discharge if they experienced an AO. Regardless of whether they experienced an AO, patients who had major functional impairment at the time of surgery were likely to leave the hospital impaired. Length of stay was nearly doubled for patients who experienced an adverse occurrence.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 2005
- Accession Number
- ADA433917
Entities
People
- Alan Silver
- Christine Llewellyn
- Lenora Rances
- Mary Rojas
Organizations
- United States Agency for Healthcare Research and Quality