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Sensitizing Surgeons to Their Outcome Has No Measurable Short-term Benefit
- Source :
- Annals of surgery. 266(5)
- Publication Year :
- 2017
-
Abstract
- OBJECTIVE Investigate if involving surgeons in outcome prediction-research and having them use a dedicated Electronic-Health-Record that provides feedback, improves patients' outcome. BACKGROUND Improvement of clinical outcome mainly relies on the declaration of adverse events, identification of their predictors, self-assessment, and feedback. METHODS Thirteen French Hepato-Pancreato-Biliary-centers made commitment to include all patients undergoing elective hepatectomies in an observational study. Each center was given access to a dedicated website, where perioperative data were prospectively collected. The website provided real-time individual and comparative feedback of outcome and was also intended to perform prognostication studies. The hypothesis was that by using this strategy, the length-of-stay would be reduced by 10%. Power-calculation implied the inclusion of 1720 patients. Secondary endpoints were 90-day mortality, severe morbidity, and the comprehensive-complication index. RESULTS Only 5 of the 13 participating centers were fully compliant in enrolling their patients and the inclusion period was extended by 1-year (October 2012-October 2015) to meet the objective. During this period, the collaborative group published 9 studies based on the study data (median impact factor = 8.327) that identified quantitative clinical variables, qualitative clinical variables, and nonclinical variables influencing outcome. For patients enrolled by the 5 active centers (n = 1752), there was no improvement in length of stay (13.3 vs 12.4 days, P = 0.287), severe complications (23.6 vs 20.5%, P = 0.134), the complication comprehensive index (24.0 vs 24.9, P = 0.448), mortality (4.1 vs 3.9%, P = 0.903), or unplanned readmissions (7.2 vs 8.4%, P = 0.665), even after adjusting for confounders. CONCLUSION Simply sensitizing surgeons to their outcome has no measurable short-term clinical benefit.
- Subjects :
- Adult
Male
medicine.medical_specialty
Self-Assessment
Feedback, Psychological
Declaration
Outcome (game theory)
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Medicine
Electronic Health Records
Hepatectomy
Humans
030212 general & internal medicine
Prospective Studies
Adverse effect
Aged
Surgeons
business.industry
Confounding
Perioperative
Length of Stay
Middle Aged
Quality Improvement
Outcome and Process Assessment, Health Care
Elective Surgical Procedures
030220 oncology & carcinogenesis
Emergency medicine
Severe morbidity
Surgery
Observational study
Female
Clinical Competence
France
business
Complication
Knowledge of Results, Psychological
Follow-Up Studies
Subjects
Details
- ISSN :
- 15281140
- Volume :
- 266
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Annals of surgery
- Accession number :
- edsair.doi.dedup.....f87ce4540ea5b69a2c2a6522497f76cd