Establishing standard hospital performance measures for cervical spinal trauma: a Nationwide In-patient Sample study.

STUDY DESIGN: A retrospective national administrative database study.

OBJECTIVE: Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are metrics for quality of health care and are linked to reimbursement. The prevalence of PSIs/HACs may impact access to health care for certain conditions. We estimated the national occurrence rates of PSIs/HACs among cervical trauma patients and identified patient factors that correlate with their occurrence.

SETTING: United States of America.

METHODS: We queried Nationwide In-patient Sample database (NIS) hospitalizations (2002-2010) for diagnoses of cervical fracture with and without spinal cord injury (SCI). The incidence of each PSI/HAC was determined by ICD-9 (International Classification of Disease, 9th Revision) codes. Multivariate analysis was used to identify the correlation between specific variables and the probability of each indicator.

RESULTS: There were 52,377 hospitalizations for cervical fracture in the NIS (without SCI, n = 41,708; with SCI, n = 10,669). Among those without SCI, there were 5374 (12.9%) reported PSIs and 117 (0.3%) HACs. Leading adverse events were postoperative respiratory failure (8.45%), pulmonary embolism (1.70%) and pressure ulcer (1.12%). Among those with SCI, there were 6600 (61.9%) PSIs and 143 (1.3%) HACs. Leading adverse events were postoperative respiratory failure (39.2%), pressure ulcer (7.78%), sepsis (5.71%), deep venous thrombosis (3.81%) and PE (1.70%). Adverse events were associated with several factors, including age, gender, Comorbidity Score and Injury Severity Score. Those with ⩾ 1 PSI/HAC had significantly longer lengths of stay (P < 0.0001) and higher hospital costs (P < 0.0001) and mortality (P < 0.0001) compared with patients without events.

CONCLUSIONS: These results estimate baseline national rates of PSIs/HACs in patients with cervical spine trauma. These data may be used to gauge individual institutional quality of care in comparison with national data.