Quality measurement, improvement of surgical care examined in the June issue of JACS

CHICAGO -- The Journal of the American College of Surgeons (JACS) devotes its June issue to a quality measurement program called the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). ACS NSQIP is the American College of Surgeons' quality improvement program that tracks the outcomes of various surgical procedures and provides data to help hospitals improve patient safety and quality of surgical care.

A number of the 20 articles included in the June issue of JACS show how ACS NSQIP helps reduce complications among surgical patients and enables surgeons to better assess a patient’s risks before he or she has an operation:

• Three hospitals reduced postoperative complications by using ACS NSQIP: One study (“Use of National Surgical Quality Improvement Program Data as a Catalyst for Quality Improvement” by Dr. K Rowell, et al) shows that hospitals can use comparative risk-adjusted adverse event data generated through ACS NSQIP to decrease complications related to surgery. The results were impressive: Wound complication rates were reduced at the Salt Lake City Veterans Affairs medical center by 47 percent; surgical site infections in patients undergoing intra-abdominal operations were reduced at the University of Virginia by 36 percent; and urinary tract infections in vascular surgery patients were reduced at the Massachusetts General Hospital by 74 percent.

• Prediction models help patients avoid complications after an operation: A group of five studies report on how ACS NSQIP data was used to develop risk assessment models to help predict which patients are susceptible to postoperative complications, such as surgical site infection, respiratory failure, or cardiac complications during or after general or vascular surgical procedures. The studies (“Multivariable Predictors of Postoperative Cardiac Adverse Events after General and Vascular Surgery,” by Dr. Daniel L. Davenport, et al; “Morbidity and Mortality after Liver Resection,” by Dr. Sophia Virani, et al; “Multivariable Predictors of Postoperative Venous Thromboembolic Events after General and Vascular Surgery,” by Dr. Selwyn O. Rogers Jr., et al; “Multivariable Predictors of Postoperative Respiratory Failure after General and Vascular Surgery,” by Dr. Robert G. Johnson, et al; and "Multivariable Predictors of Post-Operative Surgical Site Infection Following General and Vascular Surgery,” by Dr. Leigh Neumayer, et al) correlate the condition of the patient before and after an operation to determine the conditions associated with complications. For instance, Davenport’s study concludes that a patient’s risk for a heart attack is associated less with the more common cardiac risks, such as angioplasty, angina or hypertension, as it is with other conditions, such as high white cell count or diabetes. By identifying high-risk patients, surgeons can take preventive measures to avoid complications or even death.

Currently, ACS NSQIP is used in 155 private hospitals. ACS NSQIP also includes reporting for the Centers for Medicare and Medicaid Services’ (CMS) Surgical Care Improvement Program (SCIP). ACS is leading the effort to expand the adoption of ACS NSQIP in hospitals across the country.

Clifford Ko, MD, FACS, Director of the Division of Research and Optimal Patient Care, American College of Surgeons, is available to discuss these studies. Dr. Ko, a practicing surgeon, is also an Associate Professor of Surgery, Department of Surgery – UCLA School of Medicine and serves as Research Scientist for the RAND Corporation and as Director for the UCLA Center for Surgical Outcomes and Quality.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 66,000 members and it is the largest organization of surgeons in the world.