Surgical Outcomes Program

The Surgical Outcomes Program is a collaboration of surgeons, scientists and allied health staff whose goal is to improve the quality of surgical patient care at Mayo Clinic and in the United States as a whole.

Invasive surgical procedures are complex and may lead to complications and adverse events, which affect patients and contribute significantly to overall health care costs.

Areas of focus

Using Mayo Clinic and national data, the Surgical Outcomes Program focuses on four themes before, during and after surgery:

  • Quality. Quality of the surgical experience during and immediately after hospitalization.
  • Access. The socio-economic, demographic, geographical and disease factors associated with access to quality surgical care.
  • Safety. Safety during the surgical experience, including emerging technologies.
  • Outcomes. Long-term health services utilization, late effects and mortality.

By providing evidence to improve the safety, efficiency and quality of surgical care, the program aims to influence the surgical patient experience at Mayo and nationwide.

Projects

Real-time tissue analysis during surgery prevents re-operations

A Mayo Clinic study showed that frozen section analysis during breast cancer lumpectomies, which ensures surgeons remove all cancerous tissue while patients are still anesthetized, spares patients the need for a repeat lumpectomy within a month in about 96 percent of cases at Mayo Clinic in Rochester, Minnesota. Mayo's success rate is higher than the approximately 87 percent rate nationally.

These findings have significant implications for other types of surgery, patient satisfaction and cost of care. Mayo Clinic remains one of the only U.S. medical centers to perform frozen section analysis, which was pioneered at Mayo more than 100 years ago and is used in a variety of surgeries. Elizabeth B. Habermann, Ph.D., scientific director of the Surgical Outcomes Program, was senior author on the study. Read the study abstract.

Identifying risk factors for urinary tract infections in elderly trauma patients

This project aimed to determine risk factors for urinary tract infections in elderly trauma patients. Of the 33,257 patients drawn from the National Surgical Quality Improvement Program database, about 4.5 percent developed a urinary tract infection, with risk factors identified that include:

  • Being female
  • Being older than 75
  • Presence of ascites, moderate head injury, impaired sensorium or congestive heart failure
  • Duration of hospital stay

Mayo researchers determined that duration of stay has a profound impact on the development of urinary tract infections but that overall injury severity does not. In addition, given that there are multiple nonmodifiable risk factors, there may be a need for increased screening to detect occult urinary tract infections.

Evaluating reimbursement guidelines for postoperative urinary tract infections in elderly emergency surgery patients

Since 2008, the Centers for Medicare and Medicaid Services has considered postoperative urinary tract infections to be a potentially preventable condition and therefore not reimbursable. After looking at 44,100 elderly emergency surgery patients, of which 3.7 percent developed a postoperative urinary tract infection before hospital discharge, Mayo researchers found that patients developing infections have few modifiable risk factors.

Researchers concluded that in light of this, lack of reimbursement is not justified — and that while targeted interventions may be developed to prevent postoperative urinary tract infections, this complication is not easily preventable in such a challenging patient population.

Increasing care value and predictability in Mayo's adult cardiac surgery practice

Physicians, surgeons and researchers evaluated a new care model for how adult cardiac surgery patients are managed at Mayo Clinic, asking whether some portion of that population was similar enough that they could be managed in a more uniform, structured way rather than relying on physicians to individually determine each patient's course of care.

They determined that such a uniform approach was appropriate for 67 percent of cardiac surgery patients and, using industrial engineering principles and health information technology tools, crafted and implemented a new model for this segment of patients. Results showed that the new model reduced hospital length of stay, costs and amount of resources used while also decreasing variation and improving outcomes. Read the study abstract.

Reducing variability in intraoperative care and management of mechanical ventilation

This project looked at how to reduce variability in how mechanical ventilation is used in cardiac surgery at Mayo Clinic. Researchers compared the more than 50 percent of cardiac surgery patients who were managed with a standardized care model in 2012 with patients undergoing surgery in 2008, when there was no standardized model.

Results showed that the standardized model reduced median mechanical ventilation duration from 9.3 hours (2008) to 6.3 hours (2012) and intensive care unit length of stay from 26.3 hours to 22.5 hours, both of which were statistically significant. Read the study abstract.

Contact

Elizabeth B. Habermann, Ph.D.

Diane K. Olson