Summary

A Clinical Practice Improvement (CPI) study was conducted at three suburban hospitals in a mountain state to determine areas of significant improvement in the management of abdominal surgery patients.  Data were collected on 977 patients, and extensive multivariate analyses were performed.  Results show that after controlling for disease severity, several treatment variables under provider control were associated with greater increase in severity from admission (first 24 hours) to maximum during the hospital stay, longer length of stay, higher cost, and higher infection rates.

Primary Objectives

1. Improve measurable customer value by optimizing clinical outcomes, service, and price throughout the continuum of care in adult abdominal surgery.

2. Reduce rate of occurrence of surgical wound infections.

3. Create optimal treatment research-based dynamic protocols.

Methods

Data were collected on 977 patients treated during 1977 with one of four surgical procedures:  major small or large bowel procedures (260 patients), appendectomies (237 patients), inpatient lap cholecystectomies (137 patients), and outpatient lap cholecystectomies (343 patients).  Outcomes assessed included length of stay, post-operative infection, and increase in severity of illness from admission (first 24 hours) to maximum during hospital stay.  Multivariate analyses were performed on all data.

Results

1. Patient variables, including greater disease severity, greater malnutrition severity,  serum glucose > 220 any day post-operatively, and post-operative nausea/ vomiting were associated with poorer outcomes.
   

2. Controlling for patient variables, longer skin-to-skin time, longer anesthesia start to surgical incision time, use of drains, use of PCA pump or epidural for pain control, longer time to first activity, and use of central lines were associated with poorer outcomes.
   

Impact

All findings from the Abdominal Surgery – West Coast CPI study were confirmed.  In addition, it was found that post-operative serum glucose > 220 and use of central lines (not used in West Coast study patients) were associated with longer LOS, more post-operative wound infections, and greater severity of illness.