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ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 14-21

Assessing the feasibility and effects of introducing the USA National Surgical Quality Improvement Program on clinical outcomes and cost in Saudi Arabia: An observational study


1 Department of Health Informatics, Arab American University, Ramallah, Palestine; Department of Population Health, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
2 Department of Science Technology, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 University Research Co. (URC), Bethesda, MD, USA; USAID Applying Science to Strengthen and Improve Systems Project (ASSIST), Chevy Chase, MD, USA
4 Department of Health Systems and Quality Management, College of Public Health and Health Informatics, King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
5 Operation Room Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

Correspondence Address:
Shahenaz Najjar
Arab American University, Ramallah, Palestine
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JQSH.JQSH_1_20

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Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals’ surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.


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