Justin T Brady, MD1, Bona Ko, MPH, BA1, Samuel F Hohmann, PhD2, Benjamin P Crawshaw, MD1, Jennifer A Leinicke, MD, MPHS1, Scott R Steele, MD1, Knut M Augestad, MD, PhD3, Conor P Delaney, MD, PhD, MCh4. 1University Hospitals Cleveland Medical Center, 2Vizient, 3Akershus University Hospital, 4Cleveland Clinic
INTRODUCTION: Quality is the major driver for both clinical and financial assessment. There remains a need for simple, affordable, quality metric tools to evaluate patient outcomes, which led us to develop the HospitAl length of stay, Readmission and Mortality (HARM) score. We hypothesized that the HARM score would be a reliable tool to assess patient outcomes across various surgical cohorts.
METHODS AND PROCEDURES: From 2011-2015, we identified colorectal, hepatobiliary, upper gastrointestinal and hernia surgery admissions using the Vizient Clinical Database. Individual and hospital HARM scores were calculated from length of stay, 30-day readmission and mortality rates. We evaluated the correlation of HARM scores with complication rates using the Clavien-Dindo classification system with patients stratified by procedure type.
RESULTS: We identified 525,083 surgical patients, including 206,981 colorectal patients, 164,691 hepatobiliary, 97,157 hernia patients, and 56,254 upper gastrointestinal patients. Overall, 53.8% of patients were admitted electively with a mean HARM score of 2.24 and 46.2% admitted emergently with a mean HARM score of 1.45 (P<0.0001). All HARM components correlated with patient complications on logistic regression (P<0.0001). The mean length of stay increased from 3.2±1.8 days for a HARM score <2 to 15.1±12.2 days for a HARM score >4 (P<0.001). In elective admissions, for HARM categories of <2, 2 to <3, 3 to 4, and >4, complications rates were 9.3%, 23.2%, 38.8% and 71.6%, respectively. There was a similar trend for increasing HARM score in emergent admissions as well. Increasing HARM score also directly correlated with increasing severity of complication by Clavien-Dindo classification after adjusting for risk factors.
CONCLUSIONS: The HARM score is an easy to use quality metric that correlates with increasing length of stay, complication rates and complication severity across multiple surgical disciplines when evaluated on a large administrative database. This inexpensive tool could be adopted across multiple institutions to advance patient outcomes evaluation and improvement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79398
Program Number: S085
Presentation Session: SAGES Got Talent : Resident & Fellow Scientific Session
Presentation Type: ResFel