SURGICAL COMPLICATION OUTCOME (SCOUT) SCORE - A NEW METHOD TO EVALUATE QUALITY OF CARE IN VASCULAR-SURGERY

Purpose: Surgical outcome data are generally reported as raw morbidity and mortality rates, which do not necessarily reflect quality of surg ical care. The Society for Vascular Surgery has led this area with rec ommendations by the Ad Hoc Committee on Reporting Standards to establi sh standardized methods of outcome assessment in vascular surgery. The purpose of this study was to evaluate a new method for evaluating the overall quality of surgical care, which includes surgeon, nursing, an d hospital system performance. The goal of the method is to identify p roblem areas in surgical practice that can be targeted for focused imp rovement to improve outcome. Methods: A database of more than 9000 gen eral and vascular surgical cases was compiled over a 3-year period. Ev ery postoperative complication was tabulated prospectively by a surgic al nurse on a daily basis. Fifty clinically significant complication t ypes specific for vascular surgery patients were identified from a lis t of 151 postoperative events by a panel of vascular surgeons and were grouped into nine broad categories (vascular, cardiac, pulmonary, etc .). These complications reflect the entire continuum of postoperative care, including surgeon, nursing, and hospital system performance. Eac h complication type was further stratified into four grades (mild, mod erate, severe, death) and assigned a SCOUT severity score from 0 to 10 0 (0, no complication; 100, death) by the panel of surgeons. For ease of data collection and monitoring of outcome, a software program was d eveloped to run on a laptop computer and includes medical history, ris k factors, pertinent laboratory data, and the preassigned SCOUT severi ty scores for measuring outcome. In this study, 170 major vascular pro cedures performed over the previous 12-month period were prospectively evaluated using the SCOUT method in an attempt to more easily identif y problem areas of practice. In-hospital morbidity and 30-day mortalit y results were examined. Results: One hundred sixteen postoperative co mplications mere identified in the 170 patients, with an overall morbi dity rate of 51% and a 30-day mortality rate of 1.8%. Fifty-three perc ent of the complications were ''mild'' and required minimal interventi on or observation only. Abdominal aortic aneurysm repair was associate d with the highest morbidity rate (mean SCOUT score, 384.35), whereas distal extremity bypass grafting had the lowest morbidity rate (mean S COUT score, 114.4). However, subgroup analysis demonstrated that cardi ac events accounted for 52% of the morbidity associated with distal ex tremity bypass but only 34.7% of the morbidity associated with abdomin al aortic aneurysm repair (p < 0.05). Conclusions: The SCOUT score is a new technical quality of care measure that can objectively quantify surgeon and other hospital system-related performance. The SCOUT score allows the surgeon to identify problem areas that can then be targete d for improvement to positively affect outcome.