The Department of Veterans Affairs' NSQIP

Khuri, Shukri F.; Daley, Jennifer; Henderson, William; Hur, Kwan; Demakis, John G.; Aust, J. Bradley; Chong, Vernon; Fabri, Peter J.; Gibbs, James O.; Grover, Frederick L.; Hammermeister, Karl E.; Irvin, rd G; McDonald, Gerald O.; Passaro, Edward; Phillips, Laurel R. S.; Scamman, Frank; Spencer, Jeannette; Stremple, John F.

doi:10.1097/00000658-199810000-00006

Cited by 1,418 publications

(170 citation statements)

References 13 publications

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“…However, on subgroup analysis frailty remained a risk factor for adverse outcomes across different surgical procedures. An additional potential source of heterogeneity was the variability in the definition of major postoperative morbidity, although all of the scores of complication severity have been validated extensively and are commonly accepted in the surgical community17, 18, 19.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcomes were 30‐day major morbidity, defined according to the Clavien–Dindo classification17, or the National Surgical Quality Improvement Program (NSQIP)18 or the Veterans Affairs Surgical Quality Improvement Program (VASQIP)19 classification; short‐term mortality, defined as death within 90 days after operation; and long‐term mortality, defined as any death occurring before 1 year after surgery. Secondary outcomes were rates of hospital readmission and discharge to a location other than home.…”

Section: Methodsmentioning

confidence: 99%

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Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…VASQIP is a quality assessment program within VA Surgical Service whose data collection methods have been described in detail elsewhere [15][16]. Briefly, trained nurses collect information preoperatively, intraoperatively, and 30 d postoperatively with a standardized protocol for most major surgical operations performed at VA hospitals.…”

Section: Sample and Datamentioning

confidence: 99%

Determinants of postsurgical discharge setting for male hip fracture patients

et al. 2013

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Abstract-Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market factors that influence the choice of postsurgical discharge setting. Using a retrospective cohort design, we linked 11,083 veterans who had hip fracture surgeries in a Department of Veterans Affairs (VA) hospital from 1998 to 2005 as assessed by the VA National Surgical Quality Improvement Program dataset with administrative data. The factors associated with five postdischarge settings were analyzed using multinomial logistic regression. We found that few veterans (0.8%) hospitalized for hip fracture were discharged with home health. Higher proportions of veterans were discharged to a nursing home (15.4%), to outpatient rehabilitation (18.8%), to inpatient rehabilitation (16.9%), or to home (48.2%). Patients were more likely to be discharged to nonhome settings for VA-provided rehabilitation if they had total function dependence, had American Society of Anesthesiologists class 4 or 5, had surgical complications prior to discharge, or lived in counties with lower nursing home bed occupancy rates. Future research should compare postsurgical and longer-term morbidity, mortality, and healthcare utilization across these rehabilitation settings.

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“…Modeled after the Veterans Affairs Surgical Quality Improvement Program, it was designed to measure and improve the care of surgical patients [5]. ACS-NSQIP data are available to participating hospitals and affiliated individuals throughout the Unites States.…”

Section: Methodsmentioning

confidence: 99%

The Relation between Obesity and Hospital Length of Stay after Elective Lateral Skull Base Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program

O’Connell

Rizk²,

Stevens³

et al. 2015

ORL

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Purpose: Length of stay is a marker of quality and efficiency of health care delivery. The objective of this study was to identify preoperative, intraoperative, and postoperative variables that impact length of stay after lateral skull base surgery. Methods/Procedures: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2009-2012 were analyzed, and patients undergoing elective lateral skull base surgery for benign lesions of cranial nerves were identified. The primary outcome measure of interest was length of hospital stay. Protracted length of stay was defined as ≥75th percentile of length of stay for all patients. The impact of demographic factors, intraoperative variables, and postoperative complications on length of stay was assessed. Results: In total, 252 patients were included. Almost half of the patients (41.2%) were classified as obese (body mass index ≥30). Patients who were obese had significantly longer lengths of stay (5.6 ± 3.9 days) when compared to patients who were not obese (4.6 ± 3.4 days, p = 0.006). Multivariate regression analysis demonstrated that operative time, reoperation within 30 days of initial surgery, and obesity were independent predictors for protracted length of stay. Conclusion: National multi-institutional data from the ACS-NSQIP suggest that operative time, reoperation, and obesity are predictors of longer hospital stays after lateral skull base approaches for benign cranial nerve neoplasms.

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The Department of Veterans Affairs' NSQIP

Cited by 1,418 publications

References 13 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Determinants of postsurgical discharge setting for male hip fracture patients

The Relation between Obesity and Hospital Length of Stay after Elective Lateral Skull Base Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program

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