Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program
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- 1 September 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 250 (3), 363-376
- https://doi.org/10.1097/sla.0b013e3181b4148f
Abstract
The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. The objective was to show that American College of Surgeons (ACS)-NSQIP helps all enrolled hospitals. ACS-NSQIP data was used to evaluate improvement in hospitals longitudinally over 3 years (2005-2007). Improvement was defined as reduction in risk-adjusted "Observed/Expected" (O/E) ratios between periods with risk adjustment held constant. Multivariable logistic regression-based adjustment was performed and included indicators for procedure groups. Additionally, morbidity counts were modeled using a negative binomial model, to estimate the number of avoided complications. Multiple perspectives reflected improvement over time. In the analysis of 118 hospitals (2006-2007), 66% of hospitals improved risk-adjusted mortality (mean O/E improvement: 0.174; P < 0.05) and 82% improved risk adjusted complication rates (mean improvement: 0.114; P < 0.05). Correlations between starting O/E and improvement (0.834 for mortality, 0.652 for morbidity), as well as relative risk, revealed that initially worse-performing hospitals had more likelihood of improvement. Nonetheless, well-performing hospitals also improved. Modeling morbidity counts, 183 hospitals (2007), avoided ~9598 potential complications: ~52/hospital. Due to sampling this may represent only 1 of 5 to 1of 10 of the true total. Improvement reflected aggregate performance across all types of hospitals (academic/community, urban/rural). Changes in patient risk over time had important contributions to the effect. ACS-NSQIP indicates that surgical outcomes improve across all participating hospitals in the private sector. Improvement is reflected for both poor- and well-performing facilities. NSQIP hospitals appear to be avoiding substantial numbers of complications- improving care, and reducing costs. Changes in risk over time merit further study.Keywords
This publication has 6 references indexed in Scilit:
- The Impact of Surgeon Specialization on Patient MortalityAnnals of Surgery, 2009
- Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion—Results of the First American College of Surgeons–National Surgical Quality Improvement Program Best Practices InitiativeJournal of the American College of Surgeons, 2008
- Successful Implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the Private Sector: The Patient Safety in Surgery StudyAnnals of Surgery, 2008
- The Patient Safety in Surgery Study: Background, Study Design, and Patient PopulationsJournal of the American College of Surgeons, 2007
- The NSQIP: A new frontier in surgerySurgery, 2005
- The Department of Veterans Affairs' NSQIPAnnals of Surgery, 1998