From: Assessing the hospital volume-outcome relationship in surgery: a scoping review
Mortality | Length of stay | Hospital readmission | Cost | Surgical complications | General complications | Oncological issues | Characteristics of the hospital stay (continuous) | Quality indicators |
---|---|---|---|---|---|---|---|---|
Death occurring during a pre-defined time period (1, 7, 30, 60, 90 or 180 days, 1, 2, 3 or 5 years) | Continuous length of stay (from admission to discharge) | Readmission for any cause during a pre-defined time period (2 weeks, 30 days, 6 weeks, 90 days, or 1, 2, or 3 years) | Costs billed by the hospital, excluding physicians’ fees | Severity of the complication: Clavien-Dindo grade III or higher | At least one complication within a specific time period (in-hospital stay, 30 or 90 days, 75th percentile of the length of stay) or the complication rate | successful surgery: positive surgical margins (circumferential), number of resected lymph nodes, complete resection or not, restorative surgery performed or not. | Being in the intensive care unit (ICU) for longer than a specific time (1 or 2 days) or requiring organ support (mechanical ventilation or dialysis) | Patient safety indicators |
Failure-to-rescue rates: death after a major complication within a pre-defined period of time (30 days, 90-days, in-hospital) | Continuous post-surgical length of stay (from surgery to discharge) | Readmission for a specific cause (aseptic revision, rescue surgery as a full procedure after a partial one, implant revision) | Sum of all costs except the cost of initial surgery (considered to be similar across all centres) | Abscess, haemorrhage, or anastomotic leakage | Major complications, defined as the need for surgical intervention or organ supply within a specific time period (in-hospital, 14 days) | Recurrence of cancer: local recurrence, distant metastases, and vital status | Routine discharge versus nonroutine discharge (i.e. to rehabilitation, home, or a care home) | Surgical reconstruction rate |
Ratio between observed and expected (O/E) deaths | Continuous length of uninterrupted institutional care | A composite of readmission to an acute care hospital for any cause and all-cause death within a specific time period | Excess costs, defined as those above a defined cut-off (median, 75th percentile, etc.) | Surgical site bleeding, need for transfusion, or transfusion volume | Kidney failure or urinary tract infection | Risk ratios for positive margins | Time to surgery/transplantation or the door-to-balloon time | Proportion of pneumectomies |
Risk-adjusted mortality: the O/E ratio multiplied by the overall mortality rate for the cohort | Prolonged length of stay: longer than a cut-off (insurance period, median value, 75th percentile, 90th percentile, etc.) | Risk-adjusted readmission rate, the O/E ratio multiplied by the overall readmission rate for the cohort | Cost per day of treatment: the total cost divided by the length of stay | Perforation or laceration (bowel, oesophageal, ureteral, rectum, bladder, nerve, etc.) | One of the eight emergency general surgery complications | Time to recurrence or progression-free survival time | Duration of treatment with antibiotics | Amputation-free survival |
Hospital-standardized mortality ratio | Unplanned readmission to the same hospital | Cost-per-episode of surgery, adjusted for wage index | Surgical site infection, wound infection | Sepsis, septicaemia, shock, or prosthesis or implant infection | Travel time or distance to hospital | Sphincter preservation | ||
Disease-related death (cancer, surgery, or sepsis related) | Readmission rate for each subspecialty or diagnosis | Cost-per-episode of surgery, adjusted for inflation | Major amputation (lower limb, organ) | Pulmonary embolism, deep venous thrombosis | Number of hours requiring organ support | Survival of thumb replantation | ||
Time-to-death, as the time interval between surgery and death | Reoperation during the initial hospital stay | Neurological or cerebrovascular complications | Duration of surgery | |||||
Post-discharge mortality | Need for a permanent pacemaker | Duration of anaesthesia | ||||||
In-hospital mortality | Respiratory failure or arrest | |||||||
Cardiac arrest or myocardial infarction |