Surgical outcomes
The Surgical Outcomes Program in the Mayo Clinic Kern Center for the Science of Health Care Delivery collaborates with practice leaders, surgeons, anesthesiologists and other clinicians to improve the quality of surgical patient care at Mayo Clinic and worldwide.
Invasive surgical procedures are complex and may lead to complications and adverse events, which negatively affect patients and contribute significantly to overall healthcare costs.
The Surgical Outcomes Program uses Mayo Clinic institutional data and multiple sources of multicenter and national data to build evidence that informs the practice of surgery. The program improves the safety, efficiency and quality of surgery as well as the experiences of patients undergoing surgery.
Areas of focus
- Establishing Mayo Clinic as a leader in surgical safety and outcomes through national and international presentations and peer-reviewed publications.
- Facilitating data-driven transformation of Mayo Clinic's surgical practices.
- Identifying and evaluating potential improvements in surgical patient safety, outcomes and experience.
- Optimizing opioid prescribing practices for patients undergoing surgery.
- Risk-stratifying patients to guide surgical care.
- Shaping the future of Mayo Clinic's surgical practice research — and further cementing Mayo as a leader in the field — by mentoring Surgical Outcomes Research Fellows.
Projects
Postoperative opioid prescribing practices
In 2016, Mayo Clinic established an opioid stewardship program to guide efforts to address the U.S. opioid epidemic through clinical practice, research and education. Since then, researchers in the Surgical Outcomes Program have studied prescribing practices at Mayo Clinic, leading efforts to create evidence-based guidelines in every surgical department across the enterprise. The initiative brought together a diverse group including physicians, nurses, psychologists, pharmacists, research scientists, engineers, government advocates, administrators and others.
Early on, the research team discovered a wide variation in opioid prescribing habits within departments and across Mayo Clinic. In response, the team developed, implemented and refined enterprise-wide guidelines based on the individual patient's need and the type of surgery or procedure. These guidelines have led to significant drops in opioid prescriptions overall.
The investigators continue homing in on the optimal postoperative pain management strategy for each patient and nearly every surgery or procedure. At the same time, the project team refines its existing recommendations based on new research.
Many departments have shown major decreases in their opioid prescriptions. Here are a few examples:
- The Department of Orthopedic Surgery transformed its prescribing practices, reducing the opioids prescribed for patients undergoing hip or knee replacement surgeries by 48%.
- The urogynecology and reconstructive pelvic surgery group implemented opioid prescribing guidelines for prolapse surgeries. While continuing to effectively manage patients' pain within the existing enhanced recovery pathway, the group reduced opioids prescribed at discharge from an average morphine milligram equivalent (MME) of 225 MME to 71.3 MME. And many more patients chose to manage pain at home without opioids — an increase from 4.2% to 36.6%.
- In the Department of Urology, opioid prescriptions decreased for all 21 types of surgery studied. During that time, prescription refills also decreased, meaning patient pain management was not affected.
- Another study looked at patient-reported outcomes across 12 elective general surgery procedures — before and after tiered guidelines were implemented. The median prescription dropped from 140 MME to 60 MME. And 26 days after discharge, patients had less opioid medicine remaining (from 75 mg to 35 mg). A similar majority of patients — 93.3% before implementation of the guidelines versus 87.7% after — were very or somewhat satisfied with their pain control.
This work has informed state and national guidelines. Program experts often are called to provide leadership in advisory and ad hoc work groups as public health agencies develop and refine policies and programs to address the continuing opioid crisis.
Related publications:
Identifying opportunities to reduce surgical complications
Much of the research conducted by the Surgical Outcomes Program team centers on finding ways to reduce postoperative complications such as:
- Acute kidney injury.
- Surgical site infections.
- Unplanned returns to the operating room.
- Urinary tract infections.
- Venous thromboembolism.
Together with collaborators from the Department of Surgery and other areas, the team studies ways to improve the quality of patient care. Beyond reducing the likelihood of unexpected complications, this research affects the way people experience healthcare. For example, the team is finding ways to reduce the length of hospital stays and evaluating options for delivering advanced care outside traditional hospital settings.
Surgical Outcomes Program experts also work within Mayo's clinical practice to examine usual care practices. For example, they look for ways to lessen the burden of care for both patients and staff, such as comparing the overall safety and efficiency of a surgical team made up of several consistent members versus a team comprised of rotating members. Another example involves determining there was no clinical value for patients undergoing certain procedures to get lab tests in a day-after-surgery early morning blood draw — thereby decreasing the costs of care, reducing inconvenience for patients and removing risks inherent to blood draws.
Related publication:
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