ArticleBMJ open2019
Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Evaluating Clinical Implementation of Risk Prediction Based Interventions Using Difference-In-Differences.Health services research · 2026Article
- Network prediction of surgical complication clusters: a prospective multicenter cohort study.Science China. Life sciences · 2023Article
- Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study.Journal of orthopaedic surgery and research · 2023Article
- Expanding restrictive transfusion evidence in surgical practice: a multicentre, prospective cohort study.Blood transfusion = Trasfusione del sangue · 2022Article
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo develop a risk-stratified intervention strategy and evaluate its effect on reducing surgical complications.
designA multicentre prospective study with preintervention and postintervention stages: period I (January to June 2015) to develop the intervention strategy and period II (January to June 2016) to evaluate its effectiveness.
settingFour academic/teaching hospitals representing major Chinese administrative and economic regions.
participantsAll surgical (elective and emergent) inpatients aged ≥14 years with a minimum hospital stay of 24 hours, who underwent a surgical procedure requiring an anesthesiologist.
interventionsTargeted complications were grouped into three categories (common, specific, serious) according to their incidence pattern, severity and preventability. The corresponding expert consensus-generated interventions, which focused on both regulating medical practices and managing inherent patient-related risks, were implemented in a patient-tailored way via an electronic checklist system. PRIMARY AND SECONDARY OUTCOMES: Primary outcomes were (1) in-hospital death/confirmed death within 30 days after discharge and (2) complications during hospitalisation. Secondary outcome was length of stay (LOS).
resultsWe included 51 030 patients in this analysis (eligibility rate 87.7%): 23 413 during period I, 27 617 during period II. Patients' characteristics were comparable during the two periods. After adjustment, the mean number of overall complications per 100 patients decreased from 8.84 to 7.56 (relative change 14.5%; P<0.0001). Specifically, complication rates decreased from 3.96 to 3.65 (7.8%) for common complications (P=0.0677), from 0.50 to 0.36 (28.0%) for specific complications (P=0.0153) and from 3.64 to 2.88 (20.9%) for serious complications (P<0.0001). From period I to period II, there was a decreasing trend for mortality (from 0.64 to 0.53; P=0.1031) and median LOS (by 1 day; P=0.8293), without statistical significance.
conclusionsImplementing a risk-stratified intervention strategy may be a target-sensitive, convenient means to improve surgical outcomes.
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