Toward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement Program

Shiloach, Mira; Frencher, Stanley K.; Steeger, Janet E.; Rowell, Katherine S.; Bartzokis, Kristine; Tomeh, Majed G.; Richards, Karen; Ko, Clifford Y.; Hall, Bruce L.

doi:10.1016/j.jamcollsurg.2009.09.031

Cited by 1,167 publications

(752 citation statements)

References 11 publications

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“…These reviewers may track greater than 135 data points for a given patient undergoing a surgical procedure. The inter-rater reliability of data extraction by these reviewers proves to be consistent (37).…”

Section: National Surgical Quality Improvement Program (Nsqip)mentioning

confidence: 60%

Surgical research using national databases

2016

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Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations.The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

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Section: National Surgical Quality Improvement Program (Nsqip)mentioning

confidence: 60%

Surgical research using national databases

2016

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“…Our results are limited by the accuracy of reported data on the NSQIP database, although inter-rater disagreement is approximately 2%, suggesting reliable use of this data (23). Our data is limited to the 30-day complications of post-operative THA surgery as reported by NSQIP.…”

Section: Discussionmentioning

confidence: 71%

Associations between seasonal variation and post-operative complications after total hip arthroplasty

Ng¹,

Song²,

George³

et al. 2017

Ann. Transl. Med.

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Background: Total hip arthroplasty (THA) complication rates are low, but pose marked challenges during the post-operative care period. Therefore, it is important to determine which risk factors are associated with an increased rate of these complications. The purpose of this paper was to investigate the association between seasonal variations and the 30-day post-operative complication rates following THA. Specifically, we evaluated a large prospectively collected national database for: (I) overall complication rates; (II) seasonal variations in incidence; and (III) specific quarter (Q), if any, associations. Results: The overall complication rate in this cohort was 1.09%. Upon tabulation of the different post-operative THA complication incidence rates sorted by quarters, 16 out of 20 outcomes had <1% incidence rate, 3 had between a 1% and 5% incidence rate, and 1 outcome had a complication rate greater than 5% (bleeding transfusion). There were no statistical differences in 19 of the 20 complication rates when compared between the different quarters. Transfusion was the only complication with a statistically significant difference (P value <0.001) between the different quarters, which demonstrated a marked increase in Q3/Q4 (July to December), when compared to Q1 (January to March) (P<0.001).Conclusions: Overall, our results indicate a low complication rate in this cohort of patients who underwent a THA (1.09%). There was no correlation between seasonal variation and 30-day complication rates following THA, except for bleeding risk, which remains unexplained. These findings suggest that elective THA does not have to be scheduled around specific times of the year in order to avoid 30-day postoperative complications.

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“…18 It is thought to result from anti-neutrophil antigen antibodies or anti-human leukocyte antigen antibodies. [18][19][20] Transfusion volume was associated with a risk-adjusted increase in the likelihood of minor complications, [6][7][8][9][10][11][12][13] units; patients who lived were given a median of 6 [5][6][7][8][9] red blood cell units including prolonged postoperative ventilation after cardiac surgery. 8 Although respiratory complications were the most frequent type of complication, we were unable to show a specific association between respiratory complications and increased mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative through 30-day postoperative data are collected by a systematic sampling algorithm called the eight-day cycle and entered online in a Health Insurance Portability and Accountability Act (HIPAA)-compliant secure Web-based platform that can be accessed 24 hr a day. 13 We identified non-transfused patients, patients who received 1-4 units of red blood cells, and patients who received massive transfusions of at least 5 units of red blood cells intraoperatively. Components of our composite outcome are detailed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

Turan

Yang

Bonilla

et al. 2013

Can J Anesth/J Can Anesth

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Background Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality.Methods We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. Results The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (C 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma [ 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. Conclusion Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units. RésuméContexte Les transfusions massives sont associées à des taux élevés de morbidité et de mortalité; toutefois, les Presented in part at the Foundation for Anesthesia Education and Research session at the

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Toward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement Program

Cited by 1,167 publications

References 11 publications

Surgical research using national databases

Surgical research using national databases

Associations between seasonal variation and post-operative complications after total hip arthroplasty

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

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