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Patient Characteristics and the Occurrence of Never Events
Donald E. Fry, MD;
Michael Pine, MD, MBA;
Barbara L. Jones, MA;
Roger J. Meimban, PhD
Arch Surg. 2010;145(2):148-151.
Objective To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed.
Design Epidemiological analysis.
Interventions Derivation and assessment of predictive equations for postoperative infectious events and decubitus ulcers using Healthcare Cost and Utilization Project Nationwide Inpatient Sample administrative claims data for patients hospitalized between 2002 and 2005.
Main Outcome Measures C statistics for each predictive equation with and without hospital dummy variables.
Results Predictive equations for 6 of 8 complications had C statistics greater than 0.65 without hospital variables, while 2 had C statistics of less than 0.55. All equations had C statistics greater than 0.75 when hospital dummy variables were included.
Conclusions Patient characteristics and type of operative procedure are important predictors of complications of surgical care evaluated in this study, undermining the rationale for their current classification as "never events." Variations in risk-adjusted complication rates among hospitals support the influence of quality of care on their occurrence. Development and use of warranties to cover costs associated with caring for the unavoidable components of potentially avoidable complications is proposed as a means of rewarding high-quality providers without creating unrealistic expectations or perverse financial incentives.
Author Affiliations: Michael Pine and Associates (Drs Fry, Pine, and Meimban, and Ms Jones); Department of Surgery, Northwestern University Feinberg School of Medicine (Dr Fry); and Department of Medicine, University of Chicago School of Medicine, Chicago, Illinois (Dr Pine).
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