Patient Safety in Surgery

Featured article:The importance of risk-stratification for outcome prediction in vulnerable patient cohorts.

This featured article reports a large-scale analysis by researchers from Johns Hopkins University on 46,450 patients included in the National Trauma Data Bank who sustained pelvic ring injuries or acetabular fractures. The study was designed to investigate the role of morbid obesity, as defined by a body mass index (BMI) ≥40, as a risk factor for developing posttraumatic complications. The authors found that the subset of morbidly obese patients (n=1,331) had a significantly increased risk of sustaining adverse events during their hospital stay, compared to the control group with BMI <40, which include increased perioperative blood loss, a higher infection rate, and an increased risk for pulmonary and cardiovascular complications. The study cohort of morbidly obese patients also had a significantly longer hospital length of stay, compared to the control group. These data provide a compelling argument about the importance of risk stratification for vulnerable patient cohorts in the modern era of accountable care organizations with regard to value-based purchasing and bundled reimbursement rates for selected DRG’s. The knowledge of an increased baseline risk for complications must also be included in the shared decision-making process with patients when discussing operative versus non-operative treatment options.