Assessment of the Reliability of Data Collected for the Department of Veterans Affairs National Surgical Quality Improvement Program

Davis, Chester L.; Pierce, J. Rush; Henderson, William; Spencer, Craig; Tyler, C.K.G.; Langberg, Robert; Swafford, Jennan; Felan, Gladys S.; Kearns, Martha A.; Booker, Brigitte

doi:10.1016/j.jamcollsurg.2007.01.012

Cited by 211 publications

(127 citation statements)

References 5 publications

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“…VASQIP surgical clinical nurse reviewers (SCNRs) abstract postoperative data from a random sample of surgeries according to the VASQIP sampling framework: every 8 days, the first 36 consecutive surgeries are reviewed, with limitations on how many high-volume, low-risk procedures are assessed. 8,13,23 For example, only the first three breast lumpectomy procedures are included in each 8-day review cycle. 13 VASQIP postoperative complications include 20 specific AEs categorized as Wound, Respiratory, Urinary Tract, Central Nervous System (CNS), and Other Complications.…”

Section: Data Sourcesmentioning

confidence: 99%

“…7 The Veterans Health Administration (VA) developed the Veterans Affairs Surgical Quality Improvement Program (VASQIP; formerly the National Surgical Quality Improvement Program), which is considered the flagship method of surgical AE detection and quality improvement. [7][8][9][10] Its methodology has been adopted and is being increasingly used in the private sector by the American College of Surgeons (ACS-NSQIP). 11,12 VASQIP detects AEs by targeting high-volume, complex surgeries for nurse chart review using a defined list of postoperative AEs.…”

Section: Introductionmentioning

confidence: 99%

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Development and Testing of Tools to Detect Ambulatory Surgical Adverse Events

Mull

Borzecki²,

Hickson³

et al. 2013

Journal of Patient Safety

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Objectives-Numerous healthcare systems in the U.S., including the Veterans Health Administration (VA), use the National Surgical Quality Improvement Program (NSQIP) to detect surgical adverse events (AEs). VASQIP sampling methodology excludes many routine ambulatory surgeries from review. Triggers, algorithms derived from clinical logic to flag cases where AEs have most likely occurred, could complement VASQIP by detecting a higher yield of ambulatory surgeries with a true surgical AE.Methods-We developed and tested a set of ambulatory surgical AE trigger algorithms using a sample of fiscal year 2008 ambulatory surgeries from the VA Boston Healthcare System. We used VA Boston VASQIP-assessed cases to refine triggers, and VASQIP-excluded cases to test how many trigger-flagged surgeries had a nurse chart review-detected surgical AE. Chart review was performed using the VA electronic medical record. We calculated the ratio of cases with a true U.S. Department of Veterans AffairsPublic Access Author manuscript J Patient Saf. Author manuscript; available in PMC 2015 September 04. VA Author ManuscriptVA Author Manuscript VA Author Manuscript surgical AE over flagged cases (i.e., the positive predictive value (PPV)), and the 95% confidence interval for each trigger.Results-Compared to the VASQIP rate (9 AEs, or 2.8%, of the 322 charts assessed), nurse chart review of the 198 trigger-flagged surgeries yielded more cases with at least one AE (47 surgeries with an AE, or 6.0%, of the 782 VASQIP-excluded ambulatory surgeries). Individual trigger PPVs ranged from 12.4% to 58.3%.Conclusions-In comparison with VASQIP, our set of triggers identified a higher rate of surgeries with AEs in fewer chart-reviewed cases. Because our results are based on a relatively small sample, further research is necessary to confirm these findings.

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Section: Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and Testing of Tools to Detect Ambulatory Surgical Adverse Events

Mull

Borzecki²,

Hickson³

et al. 2013

Journal of Patient Safety

View full text Add to dashboard Cite

show abstract

“…National Surgical Quality Improvement Program is a well-validated data set, and audits of these prospectively collected data have shown >98% inter-rater agreement for all variables. [21][22][23] Prior studies have shown that outcome measures in the NSQIP database are more reliable than administrative data. 24 To control for potential confounders in the association between preoperative steroid use and postoperative infectious complications, we noted previously reported risk factors for postoperative complications in neurosurgical procedures using relevant variables as defined in the NSQIP database.…”

Section: Measurementsmentioning

confidence: 99%

Preoperative Steroid Use and the Risk of Infectious Complications After Neurosurgery

Merkler

Saini

Kamel

et al. 2013

The Neurohospitalist

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Background and Purpose: The association between preoperative corticosteroid use and infectious complications after neurosurgical procedures is unclear. We aim to determine whether corticosteroids increase the risk of infectious complications after neurosurgery. Methods: We examined the association between preoperative corticosteroid use and postoperative infectious complications in a cohort of adults who underwent a neurosurgical procedure between 2005 and 2010 at centers participating in the National Surgical Quality Improvement Program. Corticosteroid use was defined as at least 10 days of oral or parental therapy in the 30 days prior to surgery. Our primary outcome was a composite of any infectious complications occurring within 30 days of surgery. We used propensity score analysis to examine the independent association between preoperative corticosteroid use and postoperative infections. Results: Among 26 634 neurosurgical procedures, 1228 (4.61%, 95% confidence interval [CI], 4.36-4.86) were preceded by preoperative corticosteroid use and 1469 (5.52%; 95% CI, 5.24-5.79) were followed by postoperative infections. In a propensity score analysis controlling for comorbidities, illness severity, and preexisting preoperative infections, corticosteroid use was independently associated with subsequent postoperative infections (odds ratio, 1.38; 95% CI, 1.11-1.70). Our results were unchanged in sensitivity analyses controlling for central nervous system tumors or active treatment with chemotherapy. Conclusion: Our results suggest that preoperative corticosteroid use is associated with an increased risk of infectious complications after neurosurgery. These findings may aid physicians with preoperative treatment decisions and risk stratification. Future randomized trials are needed to guide preoperative use of corticosteroids in this population.

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“…VASQIP nurse reviewers abstract pre-, intra-, and postoperative data from surgeries sampled according to the VASQIP sampling framework: the first 36 VASQIP-eligible surgeries in an eight day period are assessed, with restrictions on the number of high-volume, low-risk procedures. 9,11,13 VASQIP nurses document each postoperative AE and the date the AE occurred. 9 Definitions of postoperative events were consistent from FY03-07; we used the FY07 VASQIP data dictionary.…”

Section: Va Surgical Quality Improvement Programmentioning

confidence: 99%

“…9 Currently, the VASQIP is the most reliable and validated method to date for surgical AE detection, 10,11 and has been adopted in the private sector by the American College of Surgeons (ACS-NSQIP). 12 The program's major limitation is the highly resource-intensive medical record review process; to minimize resource utilization, as many as 30% of major VA surgeries do not undergo VASQIP review.…”

mentioning

confidence: 99%