Does the Introduction of American College of Surgeons NSQIP Improve Outcomes? A Systematic Review of the Academic Literature

Abstract

Surgery is a central part of healthcare. It is estimated that approximately 11% of the global burden of diseases can be addressed wholly or partly by surgical care. 1 By its very nature, surgery is considered an invasive procedure and therefore carries inherent risks for patients. Based on World Health Organization data, the crude death rate after major surgery is 0.5% to 5%; up to 25% of surgical inpatients experience post-surgery complications, and surgical care accounts for almost half of all adverse events for inpatients in western countries. 2 There is no shortage of data to document the significant costs associated with surgical complications. 3-5 The World Health Organization estimated that half of surgery-associated harm is preventable. 2 Since its creation in 1913, the American College of Surgeons (ACS) has been relentless in its pursuit of the improvement of health outcomes of patients undergoing surgery. One of the major achievements of the ACS was the creation, testing, and validation of a system that captures and reports risk adjusted outcomes of surgical interventions: The National Surgical Quality Improvement Program (NSQIP). The trigger for the creation of the initial version of NSQIP was a mandate in 1985 from the US federal government (US Congress of Public Law No. 99-166) to monitor surgical outcomes in 133 Veterans Affairs Hospitals. 6 In collaboration with the ACS, the Department of Veterans Affairs conducted the National Veterans Administration Surgical Risk Study between October 1, 1991 and December 31, 1993, with the goal to define performance indicators and clinical variables and delineate how risk adjustment would be conducted. In 1994, the first version of NSQIP was introduced only in Veteran Affairs hospitals, which enabled riskadjusted comparison of surgical complications to be made across 133 hospitals. 7 This original version of NSQIP collected information on post-surgical outcomes and provided surgeon-and hospital-specific scorecards based on objective and rigorous analysis of the data. In light of the patient outcomes data generated by NSQIP, a number of quality improvement initiatives were put in place that led to reductions in mortality and morbidity in the VA hospital system, by 27% and 45%, respectively. 8 Subsequently, the NSQIP program was expanded to include private sector hospitals, with the Patient Safety in Surgery (PSS) study, which ran in parallel in the VA and a set of non-VA hospitals in 2001 to 2004, and showed clear and definite improvements in patient outcomes in both systems. 8 In 2004, NSQIP was officially branded as ACS-NSQIP. In 2005, participation in the private sector program sponsored by the American College of Surgeons (ACS-NSQIP) became available by subscription, while at the same time, the VA program separated from the private sector program and became the VA-sponsored version: VA-SQIP. Since then, the number of hospitals adopting the program has increased on a yearly basis. Over the past 13 years, the number of surgical sites that have adopted ACS-NSQIP...

Morbidity of colectomy during pancreatoduodenectomy: An analysis of the pancreas‐targeted American College of Surgeons National Surgical Quality Improvement Program Registry

“…This is not surprising considering the higher microbial load of the colon and the generally high rate of surgical site infections associated with colectomies. [12][13][14] Prior studies have demonstrated similar results showing PD + C to be associated with increased risk of infection when compared Note: Values are presented as n (%) unless specified otherwise. Variables with an overall incidence of <1% including outpatient status, transfer status, ventilator dependency, preoperative ascites, history of congestive heart failure, history of renal failure, and preoperative dialysis were omitted.…”

“…The ACS‐NSQIP database provides nationally validated, risk‐adjusted data from multiple centers for the purpose of evaluating surgical outcomes 14 . Data are collected by trained surgical clinical reviewers using uniform definitions, sampling methods, and extraction procedures with frequent data audits to ensure accuracy 15 .…”

“…The ACS-NSQIP database provides nationally validated, risk-adjusted data from multiple centers for the purpose of evaluating surgical outcomes. 14 Data are collected by trained surgical clinical reviewers using uniform definitions, sampling methods, and extraction procedures with frequent data audits to ensure accuracy. 15 Numerous independent studies have assessed and validated the utility of this prospective registry in comparing short-term surgical outcomes among participating centers.…”

Interhospital transfer (IHT) in emergency general surgery patients (EGS): A scoping review

“…These databases contain information such as inpatient utilization, access, charges, quality, and outcomes. Patient outcomes have improved since the introduction and widespread use of NSQIP, although using these databases alone will not achieve improvement in surgical quality [ 37 , 38 ]. Access to physiologic data can give researchers more data to help create a standardized EGS transfer pathway.…”

Understanding implementation context and social processes through integrating Normalization Process Theory (NPT) and the Consolidated Framework for Implementation Research (CFIR)

“…The aim of NSQIP is to improve the quality and safety of surgical care [ 18 ]. NSQIP is a widely used comprehensive data platform that enables hospitals to continuously track and measure risk-adjusted surgical morbidity and mortality outcome data to inform quality improvements (QI) [ 19 ].…”