Improved outcomes associated with a revised quality measure for continuing perioperative -blockade

Academic Article

Abstract

  • RESULTS Of 14 420 nonemergent operations with at least 2 postoperative inpatient days, 13 170 (91.3%) adhered to the original SCIP-BB measure, and 480 (3.3%) experienced a MACCE. Propensity score-matched analyses showed that adherence to the original SCIP-BB measure was not associated with MACCEs (odds ratio [OR], 1.00; 95%CI, 0.66-1.54) but was associated with increased cerebrovascular events (OR, 3.01; 95%CI, 1.00-10.07). Adherence to the revised SCIP-BB measure occurred in 11 597 (80.4%), and in matched analysis adherence was associated with decreased MACCEs (OR, 0.75; 95%CI, 0.57-0.95), cardiovascular events (OR, 0.66; 95%CI, 0.46-0.93), and 30-day mortality (OR, 0.74; 95% CI, 0.53-0.98). Adherence to the revised SCIP-BB measure was not associated with increased cerebrovascular events (OR, 1.22; 95%CI, 0.62-2.38).CONCLUSIONS AND RELEVANCE Adherence to the original SCIP-BB measure was associated with increased cerebrovascular events but not improved cardiovascular event outcomes.IMPORTANCE The Surgical Care Improvement Project perioperative -blocker (BB) (SCIP-BB) continuation measure was revised in 2012 to incorporate inpatient BB continuation after discharge from the postanesthesia care unit.OBJECTIVE To determine whether adherence to the original or revised SCIP-BB measure is associated with decreased adverse events.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using national Veterans Affairs patient-level data on adherence to the original SCIP-BB measure and inpatient BB continuation for operations between July 2006 and August 2009.METHODS Data for SCIP-BB measure adherence, inpatient BB continuation, and patient and procedure risk variables were used to estimate the associations between adherence to the original and revised SCIP-BB measures and outcomes of major adverse cardiovascular or cerebrovascular events (MACCEs) and their components of cardiovascular events, cerebrovascular events, and 30-day mortality. In addition to unadjusted estimates, propensity score matching and bootstrapping were used to estimate the associations and generate 95%CIs.MAIN OUTCOMES AND MEASURES Major adverse cardiovascular or cerebrovascular events.-Blocker continuation consistent with the revised SCIP-BB measure is associated with reduced MACCEs, cardiovascular events, and 30-day mortality. These data provide a cautionary tale of implementing performance measures before they have been rigorously tested. Although the observed associations between adherence to the revised SCIP-BB measure and outcomes are promising, they should be evaluated in the postimplementation period. Copyright© 2014 American Medical Association. All rights reserved.
  • Published In

  • JAMA Surgery  Journal
  • Digital Object Identifier (doi)

    Author List

  • Richman JS; Itani KMF; Deierhoi RJ; Henderson WG; Hawn MT
  • Start Page

  • 1031
  • End Page

  • 1037
  • Volume

  • 149
  • Issue

  • 10