Assessing Hospital Quality through Serious Complications

Hospital quality was assessed in terms of change in serious complication rate over the two time periods. Complications were identified using a subset of 8 complications from the Complication Screening Project by Iezzoni et al, ^{8 (link)} which have been previously validated, ^{5 (link)} demonstrating appropriate sensitivity and specificity for surgical conditions. These include pulmonary failure, pneumonia, myocardial infarction, deep venous thrombosis or embolism, acute renal failure, postoperative hemorrhage, surgical site infection, and gastrointestinal bleeding. Within this group of complications, serious complications were defined as the presence of one or more of the 8 complications and a length of stay greater than the 75^th percentile for the specific procedure performed. The length of stay criterion was used in order to add clinical face validity – i.e. to identify complications serious enough to have meaningful clinical impact.