We are excited to announce the launch of the Perioperative Quality Improvement Programme’s (PQIP) postoperative morbidity variable life adjusted display charts (pomVLAD) for colorectal surgery in 2023. Following a pilot study in 10 hospitals, the refined quality-improvement dashboard will now offer all sites near-real time, risk-adjusted morbidity monitoring, along with the display of key enhanced-recovery quality-improvement (QI) targets.

While major complications occur in up to 15% of surgical inpatients, PQIP’s high-risk cohort has an inpatient complication rate of 25%. These complications can increase hospital length of stay, reduce long-term survival, and negatively impact health-related quality of life.

PQIP collects multiple perioperative process and outcome measures to support research and local QI efforts. The pomVLAD rollout will enable local teams to identify trends in postoperative morbidity more rapidly than traditional analyses, allowing for timely investigation of care processes and support of local QI initiatives to improve patient outcomes.

Variable life adjusted displays (VLADs) were initially developed for monitoring observed versus expected mortality after cardiac surgery and are now widely used in medicine and surgery. A VLAD can be applied to any short-term outcome, such as postoperative complications, and compares the number of complications over time to what would be expected based on a risk-adjustment or risk-prediction model.

PQIP’s pomVLAD calculates each patient’s expected risk of postoperative morbidity using the PQIP-Colorectal (PQIP-CR)risk model, which was developed from a cohort of 11,646 colorectal patients. The model includes 12 variables and performed favourably compared to existing morbidity risk-prediction models. PomVLAD monitors morbidity at postoperative day 7 using the Postoperative Morbidity Survey (POMS).

The VLAD chart plots the predicted risk of morbidity (based on the PQIP-CR risk model) minus the observed outcome for each consecutive patient. Upward trends in the VLAD indicate lower observed postoperative morbidity than expected, while downward trends signal higher observed postoperative morbidity than expected (Figure 1 below). This innovative tool is set to revolutionize postoperative morbidity monitoring and quality improvement in colorectal surgery.

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