Chartbook on Rural Health Care

Postoperative Sepsis

Postoperative sepsis per 1,000 adult discharges with an elective operating room procedure, by hospital location, 2008-2012

2011 Achievable Benchmark: 11.3 per 1,000 Discharges.

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, 2008-2011 Nationwide Inpatient Sample and 2012 State Inpatient Databases quality analysis file, and AHRQ Quality Indicators, modified version 4.4.
Denominator: All elective surgical discharges from community hospitals for patients age 18 years and over with length of stay of 4 or more days, excluding patients admitted for infection, those with cancer or immunocompromised states, those with obstetric conditions, and admissions specifically for sepsis. Discharges from critical access hospitals are typically included while discharges from rehabilitation and long-term acute care hospitals are excluded.
Note: For this measure, lower rates are better. Rates are adjusted by age, sex, age-sex interactions, comorbidities, major diagnostic category, diagnosis-related group, and transfers into the hospital.

• Importance: Infections acquired during hospital care—also known as nosocomial infections—are among the most common complications of hospital care. Patients are particularly vulnerable to healthcare-associated infections after surgery. Hospitals in more rural areas may refer patients to hospitals in urban areas for complex surgeries.
• Change Over Time: From 2008 through 2012, the rate of postoperative sepsis did not change overall (data not shown) or for any hospital location group.
• Groups With Disparities: From 2008 to 2011, hospitals in noncore, micropolitan, and small metropolitan areas had lower rates of postoperative sepsis than hospitals in large fringe metropolitan areas (suburbs), but differences were often not statistically significant.
• Achievable Benchmark:
  • The 2011 top 4 State achievable benchmark was 11.3 per 1,000 discharges. The top 4 States were Alaska, Minnesota, Montana, and Wisconsin.
  • At current rates of improvement, the benchmark could be met in 5 to 10 years by hospitals in most metropolitan areas.
  • While having lower rates, hospitals in noncore and micropolitan areas show no movement toward the benchmark.

Potentially Inappropriate Prescription Medications

Adults age 65 and over who received potentially inappropriate prescription medications during the calendar year, by residence location, 2002-2012

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002–2012.
Note: For this measure, lower rates are better. Prescription medications received include all prescribed medications initially purchased or otherwise obtained as well as any refills. For more information on inappropriate medications, see the American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012 Apr;60(4):616-31.

• Importance: Some drugs that are prescribed for older patients are known to be potentially harmful for this age group.
• Change Over Time: From 2002 to 2012, the percentage of adults age 65 years and over who received potentially inappropriate prescription medications decreased overall (data not shown) and for all residence location groups except residents of small metropolitan areas.
• Groups With Disparities: In almost all years, the percentage of adults age 65 years and over who received potentially inappropriate prescription medications was higher among residents of noncore, micropolitan, and small metropolitan areas than among residents of large fringe metropolitan areas (suburbs), but these difference were often not statistically significant due to small sample sizes.

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