RT Journal
A1 Fry DE, Pine M, Jones BL, Meimban RJ
T1 PAtient characteristics and the occurrence of never events
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD February 1
VO 145
IS 2
SP 148
OP 151
DO 10.1001/archsurg.2009.277
UL http://dx.doi.org/10.1001/archsurg.2009.277
AB 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.