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Abstract

We would like to thank Drs Wakefield and Birkmeyer for their insightful comments regarding our article. Their editorial emphasizes the prominent role that the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) plays nationally in quality improvement. Further, they highlight the myriad of ways in which a hospital's deep vein thrombosis (DVT) rates can be confounded by the manner in which one looks for, and measures, this important complication. We suspect that most practicing surgeons are acutely aware that if one looks hard enough for trouble, you're likely to find it. Venous thromboembolism (VTE) events remain potentially preventable, thus an identifiable target for quality improvement and measurement. But, measuring results and improving quality requires that everyone “looks” for complications, and records their results, in the same manner. We agree with the group from Michigan-who are national leaders in VTE detection, measurement, and prevention,1Finks J.F. English W.J. Carlin A.M. Krause K.R. Share D.A. Banerjee M. et al.Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.Ann Surg. 2012; 255: 1100-1104Crossref PubMed Scopus (105) Google Scholar, 2Birkmeyer N.J. Dimick J.B. Share D. Hawasli A. English W.J. Genaw J. et al.Hospital complication rates with bariatric surgery in Michigan.Jama. 2010; 304: 435-442Crossref PubMed Scopus (321) Google Scholar, 3Ramacciotti E. Blackburn S. Hawley A.E. Vandy F. Ballard-Lipka N. Stabler C. et al.Evaluation of soluble P-selectin as a marker for the diagnosis of deep venous thrombosis.Clin Appl Thromb Hemost. 2011; 17: 425-431Crossref PubMed Scopus (72) Google Scholar that ACS-NSQIP needs standardized definitions to describe the manner is which the DVT was detected (symptomatic versus surveillance). Then, centers can understand their results in a meaningful manner to identify areas for improvement. Regarding “Impact of screening versus symptomatic measurement of deep vein thrombosis in a national quality improvement registry”Journal of Vascular SurgeryVol. 57Issue 1PreviewThis important study demonstrates that if one looks for particular problems, one will find them much more often than if one does not look for them.1 De Martino et al compared the National Surgical Quality Improvement Program (NSQIP) database to a predefined literature search, evaluating deep vein thrombosis (DVT) identified by symptomatic status or surveillance status. Of interest, the rate of DVT in NSQIP was essentially equivalent to the rate of symptomatic DVTs, whereas the rate in surveillance studies was much higher, ranging from 2.6-fold higher for gastric bypass to 14.5-fold higher for hip arthroplasty procedures. Full-Text PDF Open Archive