Surgical complications - AHRQ patient safety indicators
Measures of serious complications are drawn from the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs). The overall score for serious complications is based on how often adult patients had certain serious, but potentially preventable, complications related to medical or surgical inpatient hospital care. This composite or summary measure is based on the following measures:
- Collapsed lung that results from medical treatment (Iatrogenic pneumothorax, adult)
- Blood clots, in the lung or a large vein, after surgery (Postoperative Pulmonary Embolism or Deep Vein Thrombosis Rate)
- A wound that splits open after surgery (Postoperative wound dehiscence)
- Accidental cuts and tears (Accidental puncture or laceration)
- Pressure sores (Pressure ulcers)
- Infections from a large venous catheters (Central venous catheter-related blood stream infection rate)
- Broken hip from a fall after surgery (Postoperative hip fracture rate)
- Blood stream infection after surgery (Postoperative sepsis)
What patients are included
The Serious Complications measure applies only to Medicare beneficiaries enrolled in Original Medicare (traditional fee-for-service (FFS) Medicare) who were discharged from a hospital that was paid through the inpatient prospective payment system (IPPS) after the beneficiary had an inpatient stay. Non-Medicare patients and beneficiaries enrolled in Medicare managed care plans are also excluded from the data.
Where the information comes from
CMS calculates the indicators of patient safety data from the claims hospitals submit for Medicare beneficiaries enrolled in Original Medicare(traditional FFS Medicare). The rate for each PSI is calculated by dividing the actual number of outcomes at each hospital by the number of eligible discharges for that measure at each hospital, multiplied by 1,000. The composite value reported on Hospital Compare is the weighted averages of the component indicators. PSI data are only calculated for hospitals that are paid through the IPPS, which excludes Critical Access hospitals (CAHs), long-term care hospitals (LTCHs), Maryland waiver hospitals, cancer hospitals, children's inpatient facilities, rural health clinics, federally qualified health centers, inpatient psychiatric hospitals, inpatient rehabilitation facilities, Veterans Administration/ Department of Defense hospitals, and religious, non-medical health care institutions.
The measures of serious complications reported on Hospital Compare are risk adjusted to account for differences in hospital patients’ characteristics. In addition, the rates reported on Hospital Compare are “smoothed” to reflect the fact that measures for small hospitals are measured less accurately (i.e., are less reliable) than for larger hospitals.
Comparing individual hospital rates to benchmarks
For the composite measure, CMS assigns comparative performance categories. If the interval estimate includes and/or overlaps with the national composite value, the hospital’s performance is in the “no different than U.S. national rate” category. If the entire interval estimate is below the national composite value, then the hospital is performing “better than U.S. national rate.” If the entire interval estimate is above the national composite value, it is “worse than U.S. national rate.” For the individual measures, Hospital Compare displays information on each hospital’s performance category, number of cases, rate, and confidence interval.
For information about the Serious Complications measures (AHRQ Patient Safety Indicators):
- Visit the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator Resources Web site.
- Contact firstname.lastname@example.org.
- Call 1-888-512-6090
For information about Medicare's calculations and reporting of these claims-based measures: