Evaluation of hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program

Sheils, Catherine R.; Dahlke, Allison R.; Kreutzer, Lindsey; Bilimoria, Karl Y.; Yang, Anthony D.

doi:10.1016/j.surg.2016.04.034

Cited by 52 publications

(23 citation statements)

References 27 publications

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“…Finally, although the NSQIP database draws data from hundreds of hospitals and is the largest repository of detailed data on surgical cases, contributing hospitals are not nationally representative, 31 a fact that may have skewed the procedure times we used as benchmarks. We explored this possibility and did not detect evidence that our findings were substantially affected by nonrepresentativeness in NSQIP data.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

2019

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BACKGROUND The Relative Value Scale Update Committee (RUC) of the American Medical Association plays a central role in determining physician reimbursement. The RUC’s role and performance have been criticized but subjected to little empirical evaluation. METHODS We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. We compared the RUC’s estimates of procedure time with “benchmark” times for the same procedures derived from the clinical registry maintained by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). We characterized inaccuracies, quantified their effect on physician revenue, and examined whether re-review corrected them. RESULTS At the time of 108 RUC reviews, the mean absolute discrepancy between RUC time estimates and benchmark times was 18.5 minutes, or 19.8% of the RUC time. However, RUC time estimates were neither systematically shorter nor longer than benchmark times overall (β, 0.97; 95% confidence interval, 0.94 to 1.01; P = 0.10). Our analyses suggest that whereas orthopedic surgeons and urologists received higher payments than they would have if benchmark times had been used ($160 million and $40 million more, respectively, in Medicare reimbursement in 2011 through 2015), cardiothoracic surgeons, neurosurgeons, and vascular surgeons received lower payments ($130 million, $60 million, and $30 million less, respectively). The accuracy of RUC time estimates improved in 47% of RUC revaluations, worsened in 27%, and was unchanged in 25%. (Percentages do not sum to 100 because of rounding.) CONCLUSIONS In this analysis of frequently conducted operations, we found substantial absolute discrepancies between intraoperative times as estimated by the RUC and the times recorded for the same procedures in a surgical registry, but the RUC did not systematically overestimate or underestimate times. (Funded by the National Institutes of Health.)

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Section: Discussionmentioning

confidence: 99%

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

2019

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“…Lastly, free access to the database is limited to contributing institutions, and the infrastructure to contribute to the NSQIP may exceed $100,000 as a fulltime "nurse reviewer" is needed. This high cost has led to a disproportionate contribution to the NSQIP from large teaching hospitals (38). Aside from its limitations, the NSQIP database is widely believed to be the most precise and accurate database available for measuring patient outcomes after surgery given its high rate of complete data sets, operative data points, validation, and inter-rater reliability (39).…”

Section: National Surgical Quality Improvement Program (Nsqip)mentioning

confidence: 99%

Surgical research using national databases

2016

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Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations.The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

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“…Patient population is biased toward those operated at hospitals that participated in NSQIP which are usually large, academic and non-for-profit institutions; however, NSQIP hospitals have the same likelihood as non-NSQIP hospitals for being rural. 36 Also, variables are limited to those collected by NSQIP which is incomplete and prone to unmeasured confounding. For example, NSQIP does not provide information in regard to a surgeon's level of expertise.…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy for Graves’ Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study

Mohtashami

Richardson

Forest

et al. 2021

Ann Otol Rhinol Laryngol

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Objective: Examine the association of Graves’ disease with the development of postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016 to December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves’ disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’ disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves’ disease for thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other patients. The matched cohort showed that Graves’ disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery. There was no difference in recurrent laryngeal nerve injury among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to suffer from postoperative hematoma and hypocalcemia compared to patients undergoing surgery for other indications.

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Evaluation of hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program

Cited by 52 publications

References 27 publications

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule

Surgical research using national databases

Thyroidectomy for Graves’ Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study

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