Abstract
BackgroundThe HospitAl stay, Readmission, and Mortality rates (HARM) score is a quality indicator that is easily determined from routine administrative data. However, the HARM score has not yet been applied to patients undergoing bariatric surgery.ObjectiveThe aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery.MethodsA MBSAQIP 2015 PUF database was reviewed. For each discharge, a 1 to 10 score was calculated on the basis of length of stay (LOS), discharge status, and 30-day readmissions. We adjusted the LOS categories to the distribution of LOS in the MBSQIP database. The new LOS categories were used to calculate the modified HARM score, referred to as the BARiatric HARM (BAR-HARM) score. The association between HARM and BAR-HARM scores and complication rate was assessed.ResultsA total of 197,141 cases were evaluated: 98.8% were elective and 1.2% were emergent admissions. The mean individual patient BAR-HARM score was 1.75 ± 1.04 for elective cases, and 2.02 ± 1.45 for emergency cases. The complication rates for the respective BAR-HARM categories ≤ 2, > 2 to 3, > 3 to 4, and > 4 were 3.95, 27.53, 40.14, and 79.97% (p < 0.001).ConclusionsThe quality of bariatric surgery can be reliably and validly assessed using the BAR-HARM score, which is a modification of the HARM score.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users
Outcome measurement tools are required to ensure high levels of surgical quality; in particular, performance measures are needed for bariatric surgery, which has rapidly increased in popularity. [1, 2] Programs such as the Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) and the National Surgical Quality Improvement Program (NSQIP) were introduced to standardize processes, identify complications, and improve healthcare quality [3];these programs require dedicated personnel, and are expensive [4]
As bariatric surgery is associated with a shorter length of stay (LOS) and lower complication rates in comparison with colorectal surgery, we decided to adjust the LOS categories to suit the bariatric population on the basis of the MBSQIP database [10]
Summary
The aims of the present study were to adjust the HARM score to the bariatric population and to validate the ability of the modified HARM score to serve as an inexpensive tool to measure the quality of bariatric surgery. The new LOS categories were used to calculate the modified HARM score, referred to as the BARiatric HARM (BAR-HARM) score. The association between HARM and BAR-HARM scores and complication rate was assessed. The mean individual patient BAR-HARM score was 1.75 ± 1.04 for elective cases, and 2.02 ± 1.45 for emergency cases. The complication rates for the respective BAR-HARM categories ≤ 2, > 2 to 3, > 3 to 4, and > 4 were 3.95, 27.53, 40.14, and 79.97% (p < 0.001). Conclusions The quality of bariatric surgery can be reliably and validly assessed using the BAR-HARM score, which is a modification of the HARM score. Metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP)
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