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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 10

Abstract Title

Positive Predictive Value of the AHRQ Patient Safety Indicator Postoperative Sepsis

 

Author Block

Marisa Cevasco, MD, MPH1,2 Ann M. Borzecki, MD, MPH3,5 Qi Chen, MPH5  Patricia A. Zrelak, PhD, CNRN, CNAA-BC6 Marlena Shin, JD, MPH.6 Patrick Romano, MD, MPH6 Kamal M.F. Itani, MD7 Amy K. Rosen, PhD4

1VA Boston Healthcare System, Boston, MA  2Brigham and Women’s Hospital, Boston, MA  3 Bedford VAMC, Bedford, MA  5 Boston University School of Medicine, Boston, MA 6VA Boston Healthcare System, Boston, MA  7University of California, Davis, CA  8Harvard Medical School, Boston, MA

 

 

Abstract Body

Background: Patient Safety Indicator (PSI) 13, or “Postoperative Sepsis,” of the Agency for Healthcare Quality and Research (AHRQ), was recently adopted as a consensus standard for quality of care by the Centers for Medicare and Medicaid (CMS). We sought to examine its positive predictive value (PPV) by determining how well it identifies true cases of postoperative sepsis.

Methods: Two retrospective cross-sectional studies of hospitalization records that met PSI 13 criteria were conducted, one within the Veterans Administration (VA) Hospitals from fiscal year (FY) 2003 to FY 2007; and one within private sector hospitals between October 1, 2005 and March 31, 2007. Trained abstractors reviewed medical records from each database using standardized abstraction instruments. We determined the PPV of the indicator and performed descriptive analysis of cases.

Results: Of the 112 cases flagged and reviewed within the VA system, 59 were true events of postoperative sepsis, yielding a PPV of 53% (95% CI 42-64%). Within the private sector system, of 164 flagged and reviewed cases, 67 were true cases of postoperative sepsis, yielding a PPV of 41% (95% CI 28-54%). False positives were due to infections that were present on admission; urgent or emergent cases; no clinical diagnosis of sepsis; or other coding limitations such as non-specific shock in postoperative patients.

Conclusion: PSI 13 has a poor predictive ability to identify true cases of postoperative sepsis in both the VA and private sectors. Inherent coding limitations were the primary reason for false positives. As it currently stands, the use of PSI 13 for hospital reporting is premature.

 

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