Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals
Objectives Studies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups i...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e058481.full |
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| author | Ralf Kuhlen Jochen Schmitt Felix Walther Martin Roessler Peter Scriba Maria Eberlein-Gonska Olaf Schoffer |
| author_facet | Ralf Kuhlen Jochen Schmitt Felix Walther Martin Roessler Peter Scriba Maria Eberlein-Gonska Olaf Schoffer |
| author_sort | Ralf Kuhlen |
| collection | DOAJ |
| description | Objectives Studies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups is still scarce. Therefore the aim of this analysis was to investigate consistent relationships between multiple patient safety outcomes, healthcare and hospital risk factors in colorectal resection cases.Design Cross-sectional study.Setting German inpatient routine care data of colorectal resections between 2016 and 2018.Participants We analysed 54 168 colon resection and 20 395 rectum resection cases treated in German hospitals. The German Inpatient Quality Indicators were used to define colon resections and rectum resections transparently.Primary outcome measures Additionally to in-hospital death, postoperative respiratory failure, renal failure and postoperative wound infections we included multiple patient safety outcomes as primary outcomes/dependent variables for our analysis. Healthcare (eg, weekend surgery), hospital (eg, volume) and case (eg, age) characteristics served as independent covariates in a multilevel logistic regression model. The estimated regression coefficients were transferred into ORs.Results Weekend surgery, emergency admissions and transfers from other hospitals were significantly associated (ORs ranged from 1.1 to 2.6) with poor patient safety outcome (ie, death, renal failure, postoperative respiratory failure) in colon resections and rectum resections. Hospital characteristics showed heterogeneous effects. In colon resections hospital volume was associated with insignificant or adverse associations (postoperative wound infections: OR 1.168 (95% CI 1.030 to 1.325)) to multiple patient safety outcomes. In rectum resections hospital volume was protectively associated with death, renal failure and postoperative respiratory failure (ORs ranged from 0.7 to 0.8).Conclusions Transfer from other hospital and emergency admission are constantly associated with poor patient safety outcome. Hospital variables like volume, ownership or localisation did not show consistent relationships to patient safety outcomes.Trial registration number ISRCTN10188560. |
| format | Article |
| id | doaj-art-3394fbe57e8a405c806e94f0cfd6473b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-3394fbe57e8a405c806e94f0cfd6473b2025-01-31T05:35:12ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-058481Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitalsRalf Kuhlen0Jochen Schmitt1Felix Walther2Martin Roessler3Peter Scriba4Maria Eberlein-Gonska5Olaf Schoffer6Initiative Qualitätsmedizin e.V, Berlin, GermanyCenter for Evidence-based Healthcare, Medizinische Fakultät, Technische Universität Dresden, Dresden, GermanyQuality and Medical Risk Management, University Hospital Carl Gustav Carus, Dresden, GermanyCenter for Evidence-based Healthcare, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, GermanyInitiative Qualitätsmedizin e.V, Berlin, GermanyQuality and Medical Risk Management, University Hospital Carl Gustav Carus, Dresden, GermanyCenter for Evidence-based Healthcare, TU Dresden Faculty of Medicine Carl Gustav Carus, Dresden, GermanyObjectives Studies analysing colorectal resections usually focus on a specific outcome (eg, mortality) and/or specific risk factors at the individual (eg, comorbidities) or hospital (eg, volume) level. Comprehensive evidence across different patient safety outcomes, risk factors and patient groups is still scarce. Therefore the aim of this analysis was to investigate consistent relationships between multiple patient safety outcomes, healthcare and hospital risk factors in colorectal resection cases.Design Cross-sectional study.Setting German inpatient routine care data of colorectal resections between 2016 and 2018.Participants We analysed 54 168 colon resection and 20 395 rectum resection cases treated in German hospitals. The German Inpatient Quality Indicators were used to define colon resections and rectum resections transparently.Primary outcome measures Additionally to in-hospital death, postoperative respiratory failure, renal failure and postoperative wound infections we included multiple patient safety outcomes as primary outcomes/dependent variables for our analysis. Healthcare (eg, weekend surgery), hospital (eg, volume) and case (eg, age) characteristics served as independent covariates in a multilevel logistic regression model. The estimated regression coefficients were transferred into ORs.Results Weekend surgery, emergency admissions and transfers from other hospitals were significantly associated (ORs ranged from 1.1 to 2.6) with poor patient safety outcome (ie, death, renal failure, postoperative respiratory failure) in colon resections and rectum resections. Hospital characteristics showed heterogeneous effects. In colon resections hospital volume was associated with insignificant or adverse associations (postoperative wound infections: OR 1.168 (95% CI 1.030 to 1.325)) to multiple patient safety outcomes. In rectum resections hospital volume was protectively associated with death, renal failure and postoperative respiratory failure (ORs ranged from 0.7 to 0.8).Conclusions Transfer from other hospital and emergency admission are constantly associated with poor patient safety outcome. Hospital variables like volume, ownership or localisation did not show consistent relationships to patient safety outcomes.Trial registration number ISRCTN10188560.https://bmjopen.bmj.com/content/12/7/e058481.full |
| spellingShingle | Ralf Kuhlen Jochen Schmitt Felix Walther Martin Roessler Peter Scriba Maria Eberlein-Gonska Olaf Schoffer Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals BMJ Open |
| title | Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals |
| title_full | Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals |
| title_fullStr | Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals |
| title_full_unstemmed | Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals |
| title_short | Relationships between multiple patient safety outcomes and healthcare and hospital-related risk factors in colorectal resection cases: cross-sectional evidence from a nationwide sample of 232 German hospitals |
| title_sort | relationships between multiple patient safety outcomes and healthcare and hospital related risk factors in colorectal resection cases cross sectional evidence from a nationwide sample of 232 german hospitals |
| url | https://bmjopen.bmj.com/content/12/7/e058481.full |
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