American College of Surgeons National Surgical Quality Improvement Program as a Quality Improvement Tool: A Single Institution's Experience with Vascular Surgical Site Infections

Abstract

Vascular surgical site infections (VSSIs) result in significant patient morbidity and hospital cost. The objective of this study is to report a single hospital's experience using the National Surgical Quality Improvement Program (NSQIP) as an instrument to decrease VSSIs. After review of initial NSQIP data, changes in antibiotic dosage and timing, surgical preparation, patient warming, and oxygenation were put into practice. Records of all patients undergoing vascular surgical operations during a two-year period were reviewed and VSSIs were identified. Statistical comparisons were made between groups before and after implementation of these changes. A total of 478 cases met our criteria. Practice changes were introduced in October 2009 and fully implemented by January 2010. Two hundred forty-three cases were performed in 2009 and 235 in 2010. When operations during the two time periods were compared, significantly fewer VSSIs were identified in 2010 than in 2009 ( P = 0.036). NSQIP enabled our institution to identify an unacceptably high level of VSSIs. By implementing changes in our clinical practice, we were able to significantly lower our rate of VSSI.

Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial

“…34 Limiting patient and surgical heterogeneity may reveal useful outcomes, focusing efforts to prevent inadvertent hypothermia in high-risk population groups like major vascular procedures in which surgical site infections carry significant patient morbidity and hospital costs. 27 While cost analysis was not performed in our study, as this varies widely based on purchasing organization, our post hoc NNT analysis, indicating that 5.9 patients were required to prevent an additional case of hypothermia, may assist clinicians in evaluating the cost effectiveness of pre-warming interventions in preventing perioperative hypothermic complications. While criteria for significant differences in intraoperative core temperature are lacking, examining core temperature patterns throughout the perioperative period may help discriminate intervention efficacy in preventing adverse events.…”

“…The occurrence of an SSI within 30 days postoperatively and at 90 days for surgical implants (e.g., hardware, screws, mesh) was determined by the participant's surgeon and/or family doctor, according to National Surgical Quality Improvement Program criteria. 27 Secondary outcome assessors were not blinded to the assigned treatment groups.…”

Sustainability of NSQIP-Driven Protocol Changes at a Single Institution

“…Short-term follow-up revealed immediate improvement in performance in both categories. 1,2 This study aims to evaluate the longevity and sustainability of these protocol changes based on NSQIP semiannual reports.…”