Abstract
BackgroundThe American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery.Study DesignA systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI).ResultsEleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program.ConclusionsThese data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.
Highlights
The Veterans Affairs Surgical Quality Improvement Program (VASQIP), was a program developed in the 1990s to evaluate risk-adjusted surgical quality [1].The program was successful and eventually expanded to non-VA hospitals
Minimal improvements in superficial, deep and organ space infections were observed at centers that did not institute a quality improvement program
Effect of National Surgical Quality Improvement Program (NSQIP) on Surgical Quality pooled risk ratios (pRR) 0.55, 95% confidence intervals (CI) 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71)
Summary
The Veterans Affairs Surgical Quality Improvement Program (VASQIP), was a program developed in the 1990s to evaluate risk-adjusted surgical quality [1].The program was successful and eventually expanded to non-VA hospitals. The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) evolved from VASQIP in 2005, and is an outcomes-based initiative to measure and compare risk-adjusted adverse events between hospitals [2]. NSQIP data are collected by trained Surgical Clinical Reviewers through a standardized and validated process. The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery
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