Utilization of the MBSAQIP Data Registry for Bariatric Surgical Morbidity and Mortality

Transcription

1 10 min Utilization of the MBSAQIP Data Registry for Bariatric Surgical Morbidity and Mortality July 23, 2017 Anthony T. Petrick MD Director, Minimally Invasive and Bariatric Surgery Geisinger Health System, Danville, PA Co-Chair, MBSAQIP Data and Quality Committee Ellen Vogels DO, David May DO, James Dove, Nicole Fulginiti, Jon Gabrielsen MD and David Parker MD

2 Geisinger Health System Danville, PA I HAVE NO FINANCIAL DISCLOSURES

3 Introduction MBSAQIP Standard 2.1 Requires that accredited programs review adverse outcomes at least three times annually and include a review of all bariatric adverse events at these meetings. 3

4 Introduction MBSAQIP Standard 2.1 Hutter reported the limitations of the M&M conference at Massachusetts General Hospital when compared to a web-based reporting system based on an ACS-NSQIP platform. UNREPORTED About 50% of deaths About 75% of complications Hutter, Matthew M. MD, MPH, et. al., JACS, 203, No. 5, November doi: /j.jamcollsurg

5 1. Review Data MBSAQIP: all occurrence expected morbidity for sleeve gastrectomy is 4.3% and for gastric bypass is 9.8% at our institution. GMC: expected number of adverse events in patients undergoing primary bariatric procedures is about 40 per year

6 2. Identify the Problem Table #1: Number of bariatric cases reviewed per year in the General Surgery Departmental M&M conference compared with the Bariatric M&M conference. Table #1: Bariatric Cases Reviewed Annually General Surgery M&M Bariatric M&M NA NA NA For programs with high volumes, this is a suboptimal format for reporting and affecting quality improvement in a bariatric program. The reports are not timely and the opportunity for a meaningful review of a significant number of cases utilizing this format is unrealistic.

7 3. Propose Intervention Develop a Bariatric Morbidity and Mortality Conference to review ALL bariatric cases performed in our institution. Cases discharged more than thirty days prior to the meeting are selected Mortalities are reviewed at the conference immediately following the mortality and

8 4. Choose PI Methodology & Metrics All members of the section of bariatric surgery met with 100% consensus that the problem of bariatric quality review needed to be resolved. MBS director led the project. The group agreed on a monthly time for the Bariatric M&M conference and schedules were adjusted to accommodate team member schedules. Developed a QI dashboard to prospectively collect all MBSAQIP data for adverse events within 30 days of discharge including 1. Patient demographic information 2. Length of stay 3. Length of stay greater than 7 days 4. Emergency department visits 5. Readmission (greater and less than one midnight) 6. Minor reoperations (to include endoscopy) 7. Major reoperations 8. Minor adverse events (classified by Charlson-Dado score) 9. Major adverse events (classified by Charlson-Dado score) 10. Mortality within 90 days of discharge

9 5. Implement Intervention & Monitor Data Table #1: Number of bariatric cases reviewed per year in the General Surgery Departmental M&M conference compared with the Bariatric M&M conference. Table #1: Bariatric Cases Reviewed Annually General Surgery M&M Bariatric M&M NA NA NA

10 6. Present Study Results [VALU E] [VALU E] Mean # Cases Reviewed M&M Cases Departmental Bariatric 100% of bariatric patients experiencing adverse events were reviewed as defined by MBSAQIP. 100% of mortalities were identified and reported within 30 days Overall attendance at the Bariatric M&M conference from was greater than 90% for faculty, fellows, MBSCR, MBS coordinator and nurse specialists.

11 Summary 1) MBSAQIP real-time online data was utilized to create a monthly QA database 2) MBS Director working with bariatric team coordinated schedules to create a monthly Bariatric M&M Conference i. Attendance > 90% ii. Cases presented improved from 9% to 100%