Blueprint for a New American College of Surgeons: National Surgical Quality Improvement Program

Birkmeyer, John D.; Shahian, David M.; Dimick, Justin B.; Finlayson, Samuel R.G.; Flum, David R.; Ko, Clifford Y.; Hall, Bruce L.

doi:10.1016/j.jamcollsurg.2008.07.018

Cited by 331 publications

(177 citation statements)

References 13 publications

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“…Patient variables from more than 250 participating institutions nationwide are included in the ACS NSQIP 1 , and this database has been used to analyze trends and associations in orthopaedic surgery [15,17,28]. The method of data abstraction from the ACS NSQIP 1 participant files has been described [4,18]. Patients were identified through Current Procedural Terminology (CPT) codes and included patients undergoing TKA (CPT 27447), THA (CPT 27130), single-level posterior or posterolateral lumbar fusion (CPT 22612 with no CPT modifiers), multilevel posterior or posterolateral lumbar fusion (CPT 22612 with a CPT modifier of 22614), single-level anterior cervical discectomy and fusion (CPT 22551 with no CPT modifiers), multilevel anterior cervical discectomy and fusions (CPT 22612 with a CPT modifier of 22552), and total shoulder arthroplasty (CPT 23472).…”

Section: Methodsmentioning

confidence: 99%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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Background Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. Questions/purposes Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. Methods Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program 1 database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. Results A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI,

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Section: Methodsmentioning

confidence: 99%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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“…They may even be falsely reassuring and result in missed opportunities for improvement. [9] For example, a hospital's poor performance in colorectal surgery may be masked by better-than-average outcomes in trauma surgery, or vice versa. Procedure-specific performance measures would alleviate such problems.…”

Section: Researchmentioning

confidence: 99%

A multicentre evaluation of emergency abdominal surgery in South Africa: Results from the GlobalSurg-1 South Africa study

2016

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Background. GlobalSurg-1 was a multicentre, international, prospective cohort study conducted to address the global lack of surgical outcomes data. Six South African (SA) hospitals participated in the landmark surgical outcomes study. In this subsequent study, we collated the data from these six local participants and hypothesised that the location of surgery was an independent risk factor for an adverse outcome following emergency intraperitoneal surgery. Methods. Participating hospitals contributed 30-day outcomes data of consecutive emergency intraperitoneal surgical operations performed during a 2-week period between July and November 2014. The six heterogeneous hospital cohorts were compared by categorical confounders. The primary outcome measure was in-hospital mortality; secondary outcome measures were in-hospital morbidity and length of stay of >14 days. The unadjusted association between hospital and adverse outcome and the univariate association between categorical confounders and adverse outcome were tested. Significant associations were further tested by a multivariate stepwise forward logistic regression model built for each outcome of interest. Results. Six hospitals (designated 1 -6) contributed outcomes data for 169 operations. The mean age of the patients was 34.9 years (range 9 -82), 116 (68.6%) were male, and the majority (37.2%) presented as a result of trauma. Hospital 5 was associated with 76-fold increased odds of in-hospital death and 58-fold increased odds of a major in-hospital complication, and hospital 3 was associated with 3-fold increased odds of any in-hospital complication. The final model predicting in-hospital death had a receiver operating characteristic curve statistic of 0.8892. Conclusion. The hospital is an independent risk factor for risk-adjusted adverse outcomes following emergency intraperitoneal surgery in SA.

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“…Although the ACS NSQIP database originally focused on general and vascular surgery, it has since developed into a multispecialty model [3]. With this recent expansion, orthopaedic surgeons can now use the expansive clinical data provided through the ACS NSQIP to conduct largescale, multiinstitutional studies.…”

Section: Introductionmentioning

confidence: 99%

Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery

Molina¹,

Thakore²,

Blumer³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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119

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Background The goal of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is to improve patient safety. The database has been used by hospitals across the United States to decrease the rate of adverse events and improve surgical outcomes, including dramatic decreases in 30-day mortality, morbidity, and complication rates. However, only a few orthopaedic surgical studies have employed the ACS NSQIP database, all of which have limited their analysis to either single orthopaedic procedures or reported rates of adverse events without considering the effect of patient characteristics and comorbidities.

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Blueprint for a New American College of Surgeons: National Surgical Quality Improvement Program

Cited by 331 publications

References 13 publications

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

A multicentre evaluation of emergency abdominal surgery in South Africa: Results from the GlobalSurg-1 South Africa study

Use of the National Surgical Quality Improvement Program in Orthopaedic Surgery

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