The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes

Benjamin P Crawshaw; Deborah S Keller; Justin T Brady; Knut M Augestad; Nicholas K Schiltz; Siran M Koroukian; Suparna M Navale; Scott R Steele; Conor P Delaney

doi:10.1016/j.amjsurg.2016.11.007

The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes

Am J Surg. 2017 Mar;213(3):575-578. doi: 10.1016/j.amjsurg.2016.11.007. Epub 2016 Nov 8.

Authors

Benjamin P Crawshaw¹, Deborah S Keller¹, Justin T Brady¹, Knut M Augestad¹, Nicholas K Schiltz², Siran M Koroukian², Suparna M Navale², Scott R Steele¹, Conor P Delaney³

Affiliations

¹ Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
² Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-4945, USA.
³ Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. Electronic address: delanec@ccf.org.

PMID: 27842731
DOI: 10.1016/j.amjsurg.2016.11.007

Abstract

Background: The HospitAl length of stay, Readmissions and Mortality (HARM) score is a simple, inexpensive quality tool, linked directly to patient outcomes. We assess the HARM score for measuring surgical quality across multiple surgical populations.

Methods: Upper gastrointestinal, hepatobiliary, and colorectal surgery cases between 2005 and 2009 were identified from the Healthcare Cost and Utilization Project California State Inpatient Database. Composite and individual HARM scores were calculated from length of stay, 30-day readmission and mortality, correlated to complication rates for each hospital and stratified by operative type.

Results: 71,419 admissions were analyzed. Higher HARM scores correlated with higher complication rates for all cases after risk adjustment and stratification by operation type, elective or emergent status.

Conclusions: The HARM score is a simple and valid quality measurement for upper gastrointestinal, hepatobiliary and colorectal surgery. The HARM score could facilitate benchmarking to improve patient outcomes and resource utilization, and may facilitate outcome improvement.

Keywords: Colorectal; Hepatobiliary; Outcomes.

Publication types

Validation Study

MeSH terms

Adult
Aged
Aged, 80 and over
Benchmarking
California / epidemiology
Digestive System Surgical Procedures* / mortality
Elective Surgical Procedures
Female
Hospital Mortality*
Humans
Length of Stay*
Male
Middle Aged
Patient Outcome Assessment
Patient Readmission*
Postoperative Complications
Quality of Health Care*
Reproducibility of Results
Retrospective Studies