Open AccessDetecting Hospital Outliers in Post‐Pancreatectomy Care Using Funnel Plots from 2009–2018 Based on Nationwide Medico‐Administrative Data
Author(s) -
Bernard Alain,
Cottenet Jonathan,
Aho Serge,
Doussot Alexandre,
Mariet AnneSophie,
Facy Olivier,
Quantin Catherine
Publication year - 2021
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-021-06078-4
Subject(s) - funnel plot , medicine , outlier , mortality rate , total pancreatectomy , general surgery , demography , emergency medicine , pancreatectomy , pediatrics , surgery , statistics , pancreas , confidence interval , publication bias , mathematics , sociology
Objectives Our objective was to identify hospitals with unusual mortality rates for major pancreatectomies over a period of ten years using 30‐day mortality data from the French national database. Methods Data for all patients who underwent pancreatectomy were extracted from the national medico‐economic database ( Programme de Médicalisation des Systèmes d'Information ). To identify quality outliers for each hospital, the observed‐to‐expected 30‐day mortality rates were used as a quality indicator. Results A total of 19 494 patients underwent a major pancreatectomy in France between January 2009 and December 2018. The overall 30‐day mortality rate was 4.8% ( n = 944). For the 2009–2014 period, the funnel plot showed that 10 of the 176 hospitals lie outside the central 95% region and 7 lie outside the central 99.8% region. For the 2015–2018 period, out of 176 hospitals, 6 lie outside the central 95% region and 2 lie outside the central 99.8% region. The change in standardized mortality ratios between 2009–2014 and 2015–2018 testing for differences from the overall change, they were there 4 hospitals lie outside the central 95% region and 0 lie outside the central 99.8% region. Conclusion Over time, the improvement in hospital quality was weak. This study suggests that there is a pressing need to reorganize the supply of care for pancreatic surgery in France.