Comparison of Outcomes Between the National Surgical Quality Improvement Program and an Emergency General Surgery Registry

Abstract

Background: The National Surgical Quality Improvement Program (NSQIP) has become a prevalent tool for quality improvement. At our tertiary military hospital, NSQIP collects 20% of eligible cases. We implemented an emergency general surgery (EGS) registry to prospectively review all EGS cases. We compared our EGS registry with NSQIP, hypothesizing that NSQIP sampling under-represents EGS outcomes. Methods: A formal EGS Process Improvement Program was implemented in 2016. From 2016 to 2018, the four most common operations were laparoscopic appendectomy, laparoscopic cholecystectomy, surgery for small bowel obstruction, and nonelective hernia repair. Outcomes were compared between the EGS registry and NSQIP abstracted cases. Results: In 2016, the EGS registry identified 11/112 (9.8%) patients with a complication. National Surgical Quality Improvement Program abstracted 16% of EGS cases with 16.7% (3/18) of patients having a complication. In 2017, the EGS registry identified 10/87 (11.5%) cases with complications. National Surgical Quality Improvement Program abstracted 23% of EGS with zero complications. In 2018, the EGS registry identified 9.5% of 74 cases with complications. National Surgical Quality Improvement Program abstracted 15% of EGS cases with zero complications. Conclusions: National Surgical Quality Improvement Program did not capture many important EGS outcomes. In 2 of 3 years, NSQIP did not identify a single complication for EGS. National Surgical Quality Improvement Program alone may be insufficient to target EGS improvements.

Development and implementation of an automated electronic health record–linked registry for emergency general surgery

“…The recently developed TQIP model, while successful in demonstrating value in capturing EGS patients and tracking their outcomes compared with existing databases, is limited by the associated costs 7 . It requires a dedicated team for data collection and abstraction that does not decrease over time.…”

“…6 The recently developed TQIP model, while successful in demonstrating value in capturing EGS patients and tracking their outcomes compared with existing databases, is limited by the associated costs. 7 It requires a dedicated team for data collection and abstraction that does not decrease over time. While TQIP is a customary or mandatory trauma center expense, there is not yet a current funding for a TQIP-like model for EGS registries, and this makes widespread adoption and implementation unlikely soon.…”