- Assure Best Outcomes - Create Seamless Service; Excel in Personalised Care
Singapore General Hospital (SGH) is committed towards delivering quality service and ensuring the best outcomes for our patients. As a testimony to our commitment, we are sharing with members of the public, information that reflects our quality care including clinical outcomes. This information can also enable members of the public and their referring primary healthcare providers make informed decisions regarding their hospital of choice.
1) Rehabilitation Outcomes
2) Laparoscopic Cholecystectomy Outcomes
3) Tonsillectomy Outcomes
Improved survival rates and increased longevity has resulted in the increased prevalence of chronic conditions. Functional losses from chronic conditions are typically more persistent, often progressive and potentially reversible with rehabilitation. Functional outcome measures for patients with chronic conditions enables accurate assessment of functional loss, allows serial assessment at various time intervals, identifies/ measures changes in individual or group of individuals and provides indicator of rehabilitation program's effectiveness.
Figure 1a. Functional Independence Measure Scores of 865 stroke patients admitted to the Department of Rehabilitation Medicine, Singapore General Hospital, over a 4-year period from July 2002 to June 2006. Functional Independence Measure Total range from 18 (most disability), to 126 (no disability).
Source: Dept of Rehabilitation Medicine, SGH
Reference: Ng YS, Jung H, Tay SS, Bok CW, Chiong Y, Lim PA. Results From a Prospective Acute Inpatient Rehabilitation Database: Clinical Characteristics and Functional Outcomes using the Functional Independence Measure. Ann Acad Med Singapore. 2007 Jan;36(1):3-8.
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Cholecystectomy is a surgery to remove the gallbladder. Traditional open cholecystectomy is a major abdominal surgery in which the gallbladder is removed through a wide abdominal incision measuring more than 10cm usually. Laparoscopic cholecystectomy (keyhole surgery) has now replaced open cholecystectomy as the first-choice of treatment for gallstones. Potentially serious complications with laparoscopic cholecystectomy include injury to the common bile duct and uncontrolled bleeding. When these complications occur, surgeons may need to convert a laparoscopic cholecystectomy to an open cholecystectomy to manage the complications.
Figure 2a. Proportion of laparoscopic cholecystecomies requiring management of bile duct injuries in year 2006.
Figure 2b. Proportion of laparoscopic cholecystecomies requiring management of uncontrolled bleeding in year 2006.
Source: Dept of Quality Management, SGH
Outcomes
A tonsillectomy is a surgery to remove the tonsils which are tissues on either side of the throat, and is commonly undertaken due to recurrent infections. A potentially serious complication of this usually safe surgery is uncontrolled bleeding over the wound site after the operation.
Figure 3a . Proportion of patients with post-operative uncontrolled bleeding that requires management under general anaesthesia in the emergency operating theatre in year 2006.
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Ventilator-associated pneumonia (VAP) refers to lung infection which occurs in patients who have required mechanical breathing through a tube in the upper airway tract for at least 48 hours. Patients requiring mechanical breathing are usually managed in the Intensive Care Units (ICUs). We benchmark our rates against the US National Nosocomial Infection Surveillance System (NNIS). The Ventilator Associated Pneumonia (VAP) rate is calculated as follows:
VAP Rate = Number of VAPs X 1000
Number of Ventilator-Days
Table 4a. Ventilator-associated pneumonia (VAP) rates in the SGH Intensive Care Units, benchmarked against VAP rates from U.S. National Nosocomial Infection Surveillance System (NNIS).
|
Intensive Care Unit types |
SGH VAP rate in 2006 |
NNIS mean VAP rate (Jan 1992 to Jun 2004) |
|
Surgical ICU |
5.5 |
9.3 |
|
Medical ICU |
1.2 |
4.9 |
Source: Infection Control Unit, SGH
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Knee replacement surgery is an operation that replaces the joint surfaces of the diseased and painful knee with implants to relieve pain and disability. 1064 patients underwent such surgeries in year 2004.
Table 5a. Proportion of patients who developed complications after the surgery
|
Type of complications |
Percentage |
Remarks |
|
Post-operative infection |
3.5% |
2.9% were superficial infections |
|
Deep Vein Thrombosis |
0.3% |
|
Figure 5b. Self-reported mean Oxford knee score of patients at 6 months and 2 years after the operation. The questionnaire assesses pain, function and stability of patients. 12 points is the best possible score and 60 points is the worst possible score.
Source: Singhealth Health Service Research
Haemorrhoids (piles) are swollen veins in the rectum and anus, often causing pain and bleeding. In symptomatic cases, conventional haemorrhoid surgery is usually performed. A new surgical technique – the stapled haemorrhoid surgery, first introduced in the late 1990s, was reported to be less painful, as safe as the conventional method (i.e. comparable complication rates) and has faster recovery rate (i.e. return to normal activity)1. SGH has since modified and improved on the technique. Over a period of 7 years, 6630 cases have been performed and more than 90% of our patients had a satisfactory outcome. The two most common complications noted were that of post-op bleeding which required admission (4.2%) and temporary retention of urine requiring catherisation (2.6%). Our results compare favourably internationally. Our department results are compared with a recent published review as shown below.
Table 6. Selected complication rates of stapled haemorrhoid surgery in SGH benchmarked against the reported New Zealand experience
|
|
|
New Zealand experience
(n = 738) |
SGH experience^
(n = 6631) |
|
SN |
Complications* |
% of cases |
% of cases |
|
1 |
Postoperative bleeding requiring hospitalization |
4.2% |
4.2% |
|
2 |
Urinary retention requiring catheterisation |
1.9% |
2.6% |
|
3 |
Anal stricture |
1.1% |
1.1 |
|
4 |
Persistent anal pain |
1.5% |
0% |
|
5 |
Residual disease requiring surgery or outpatient intervention |
4.6% |
0.2% |
*Slight differences in classification may exist
^Source: Dept of Colorectal Surgery, SGH
References:
1. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet. 2000 Mar 4;355(9206):782-5.
2. Hill A. Stapled haemorrhoidectomy-no pain, no gain? N Z Med J. 2004 Oct 8;117(1203):U1104. Review.
3. Ravo B, Amato A, Bianco V et. al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol. 2002 Sep;6(2):83-8.
4. Ch'ng S, Hulme-Moir M. New Zealand's early experience in stapled haemorrhoidopexy. N Z Med J. 2006 Mar 10;119(1230):U1880.
5. KH Ng, KS Ho, BS Ooi, CL Tang, KW Eu. Experience of 3711 stapled hemorrhoidectomy operations. British Journal of Surgery 2006;93:226-230.
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Joint aspirations and injections are common medical procedures used for both diagnosis and treatment. The fluid aspirated can be sent for laboratory tests to help aid diagnosis, at the same time reducing joint swelling. Joint injection is also an effective way of delivering medication to an affected area and is used in patients with arthritis (e.g. rheumatoid arthritis or osteoarthritis) or rheumatism. A rare, but serious complication of joint aspiration and injection is joint infection after the procedure. The reported incidence of post-injection joint infection is 1:3,000 – 1:50,000 according to large reported series, mainly from the United States. A clinical audit was conducted by the SGH Department of Rheumatology and Immunology on all joint aspirations/injections performed by the department from November 2003 to December 2004. None of our patients developed joint infection after the procedure,. which is consistent with the reported rates from the medical literature.
Table 7. Audit on joint aspirations/injections performed
|
Period |
Number of patients with joint aspirations / injections performed |
Number of patients admitted for joint infection within 2 months of the procedure |
|
Nov 2003 – Dec 2004 |
97 |
0 |
Reference:
1. Charalambous CP, Tryfonidis M, Sadiq S, Hirst P, Paul A. Septic arthritis following intra-articular steroid injection of the knee - a survey of current practice regarding antiseptic technique used during intra-articular steroid injection of the knee. Clin Rheumatol. 2003 Dec;22(6):386-90.
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Approximately 10% of couples are unable to conceive after 1 year of unprotected intercourse. In vitro fertilisation (IVF) is a method of treating infertility when other methods of achieving conception have failed. The egg cells are fertilised by sperm outside the woman's womb and is then transferred to the patient's uterus with the intent to establish a successful pregnancy. There are several factors that determine success and they include age, quality of the eggs and sperm, duration of the infertility, the health of the uterus, and the medical expertise. We compare favourably in the IVF success rates when benchmarked with rates reported by many European countries and the United States.
Table 8. In Vitro Fertilization Success Rate (%) in European countries, United States and SGH
|
SN |
Countries, year |
Pregnancies per cycle |
Pregnancies per transfer |
|
1 |
European countries, 2003 (range) |
20.1% to 34.1% |
23.4% to 40.0% |
|
2 |
United States, 2003 |
34.4% |
Not available |
|
3 |
SGH, 2005 |
35.2%
(n = 176) |
38.3%
(n = 162) |
Source: Department of Obstetrics & Gynaecology, SGH
References:
1. Van Voorhis, B.J., Clinical practice. In vitro fertilization. N Engl J Med, 2007. 356(4): p. 379-86.
2. Cohen, J., et al., The early days of IVF outside the UK. Hum Reprod Update, 2005. 11(5): p. 439-59.
3. Nyboe Andersen, A., et al., Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Hum Reprod, 2007: p. [Epub ahead of print].
4. 2003 Assisted reproductive technology (ART) report. Atlanta: Centers for Disease Control and Prevention, 2003, (Accessed 04 May, 2007, at http://www.cdc.gov/ART/ART2003/index.htm).
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Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland. It afflicts the majority of elderly men, and more men are expected to require treatment with our society’s aging population. For the past 50 years, transurethral resection of the prostate (TURP) has been the mainstay of treatment. Complications of this surgery include excessive post-operative bleeding, failure to pass urine, and development of postoperative infection. A clinical audit conducted by the SGH Urology Department showed favorable results when compared to results from a randomized clinical trial involving 120 men who underwent TURP in Britain in 2005.
Table 9. Performance indicators of TURP
|
SN |
Performance indicators |
SGH (n=455) |
Britain (n=120) |
|
1 |
Blood transfusion after the operation |
6.5% |
7.5% |
|
2 |
Average length of stay in hospital for these patients |
2.6 days |
4.6 days |
Source: Department of Urology, SGH
Reference:
1. Fowler C, McAllister W, Plail R, Karim O, Yang Q. Randomised evaluation of alternative electrosurgical modalities to treat bladder outflow obstruction in men with benign prostatic hyperplasia. Health Technol Assess. 2005 Feb;9(4):iii-iv, 1-30.
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Methicillin-resistant Staphylococcus aureus (MRSA) are bacteria that have acquired antibiotic resistance to all penicillin antibiotics and is a major cause of hospital-acquired infections worldwide. Such infections are typically more common in tertiary hospitals that manage patients with complex diseases and these infections can potentially delay the recovery of patients and increase both cost and duration of hospitalizations. SGH has put in place many measures to control the problem and achieved recognizable improvement over time. The following table shows reduced nosocomial MRSA infections from 2000 to 2006 in SGH.
Table 10. Incidence rate of nosocomial MRSA infections (per 1000 patient-days) from 2000 to 2006 in SGH
|
SGH |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
|
Incidence rate of nosocomial MRSA infections (per 1000 patient-days) |
1.3 |
1.2 |
1.0 |
0.9 |
0.7 |
0.8 |
0.7 |
Source: Department of Infection Control
Reference:
1. Aires de Sousa, M., and H. de Lencastre. 2004. Bridges from hospitals to the laboratory: genetic portraits of methicillin-resistant Staphylococcus aureus clones. FEMS Immunol. Med. Microbiol. 40:101–111.
2. Chen YY, Chou YC, Chou P. Impact of nosocomial infection on cost of illness and length of stay in intensive care units. Infect Control Hosp Epidemiol. 2005 Mar;26(3):281-7.
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Oral anticoagulation (blood thinning) therapy has been used to reduce the risk of blood vessel blockages in a wide variety of diseases involving the heart, lungs and brain for more than 40 years. It is estimated that 5 million patients worldwide takes anticoagulation (blood thinning) medications regularly. An adverse risk of this life-saving medication is major hemorrhage (severe bleeding), especially if its effects fail to be kept within the therapeutic range. Results of SGH’s anticoagulation clinic compare favorably with results from representative practices internationally (routine medical care in the US, Canada, and France; anticoagulation clinics in Italy and Spain).
Table 11. Percentage of patients’ test results that are within therapeutic range
| |
% Patients’ test results within therapeutic range |
Number of patients reviewed (n) |
|
Italy |
69% |
177 |
|
Singapore General Hospital, SGH |
65% |
228 |
|
Spain |
64% |
215 |
|
Canada |
61% |
145 |
|
France |
58% |
247 |
|
United States |
57% |
600 |
Source: Department of Haematology, SGH
- Yang, D.T., R.S. Robetorye, and G.M. Rodgers, Home prothrombin time monitoring: a literature analysis. Am J Hematol, 2004. 77(2): p. 177-86.
- Ansell, J., et al., Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of anticoagulation management (ISAM). J Thromb Thrombolysis, 2007. 23(2): p. 83-91.
- Samsa, G.P., et al., Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med, 2000. 160(7): p. 967-73.
In SGH, we strive not only to ensure that patients achieve the best possible clinical outcomes, but also experience a high level of personalized, seamless care. This is because we recognize it is equally important to our patients that while we possess the full capabilities of science, we must remain highly adept in the art of healing. SGH has seen marked improvement over a 3-year period from 2005 to 2007 and is currently ranked first among the tertiary hospitals and is ranked second, if we include the comparisons with regional hospitals as well.
Table 12. Percentage of patients who rated their overall satisfaction level as excellent or good.
Source: MOH
Note: Figures are rounded off
Diabetes is a major cause of death and disability in Singapore and other developed countries. With timely and appropriate treatment, many of the long-term complications such as heart disease and kidney failure could be prevented. The Medisave for Chronic Disease Management Programme was launched by Ministry of Health in late 2006 and we benchmark our performance against the MOH rates obtained in the first year of the programme launch.
Table 13. Percentage of diabetic patients with the comprehensive clinical assessments performed in 2007
|
|
Clinical assessments performed in year 2007 |
MOH n= 27,930
(%) |
SGH n=2,765
(%) |
|
1 |
Two HbA1c Tests
(to assess the long-term response to treatment) |
79.1 |
85.6 |
|
2 |
Two Blood Pressure Measurements
(to manage the overall risk of heart disease and stroke) |
68.9 |
54.3 |
|
3 |
Two Bodyweight Measurements
(to manage the overall risk of heart disease and stroke) |
56.4 |
65.5 |
|
4 |
One LDL-Cholesterol Test
(to manage the overall risk of heart disease and stroke) |
74.8 |
74.2 |
|
5 |
One Nephropathy Assessment Test
(to assess the presence of kidney complications) |
62.4 |
54.6 |
Reference:
1. MOH. First year results of the Medisave for Chronic Disease Management Programme (CDMP)
(Accessed on 11th Sep 08, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2008/CDMP%20OP.pdf)
Hypertension is a common disease affecting 1 in 4 Singaporeans. Patients with hypertension have increased risks of heart disease, stroke and kidney failure which can be reduced by timely and appropriate management. The Medisave for Chronic Disease Management Programme was launched by Ministry of Health in late 2006 and we benchmark our performance against the MOH rates obtained in the first year of the programme launch.
Table 14. Percentage of hypertensive patients with the comprehensive clinical assessments performed in 2007
|
|
Clinical assessments performed in year 2007 |
MOH n= 6848
(%) |
SGH n=1004
(%) |
|
1 |
Two Blood Pressure Measurements
(to assess the response to treatment) |
69.4 |
41.3 |
|
2 |
One Bodyweight Measurement
(to manage the overall risk of heart disease and stroke) |
87.6 |
85.5 |
Reference:
1. MOH. First year results of the Medisave for Chronic Disease Management Programme (CDMP)
(Accessed on 11th Sep 08, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2008/CDMP%20OP.pdf)
Hypercholesterolemia contributes significantly to the risk of heart disease and stroke which are the major causes of death in Singapore. With timely and appropriate management, these risks could be reduced. The Medisave for Chronic Disease Management Programme was launched by Ministry of Health in late 2006 and we benchmark our performance against the MOH rates obtained in the first year of the programme launch.
Table 15. Percentage of patients with hypercholesterolaemia having the clinical assessment performed in 2007
|
|
Clinical assessments performed in year 2007 |
MOH n= 406
(%) |
SGH n=39
(%) |
|
1 |
One LDL-Cholesterol Test
(to assess the response to treatment) |
77.8 |
69.2 |
Reference:
1. MOH. First year results of the Medisave for Chronic Disease Management Programme (CDMP)
(Accessed on 11th Sep 08, at http://www.moh.gov.sg/mohcorp/uploadedFiles/Publications/Information_Papers/2008/CDMP%20OP.pdf)
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