Surgical Quality Improvement

American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)
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This program uses clinical data to understand and identify opportunities for improvement in these areas.

Surgery Quality Improvement Committee - Brigham and Women's Hospital

It allows us to compare our practices and outcome with other hospitals across North America. As part of this program, patients may be contacted after their surgery for a follow-up so that we can work together to improve the care we provide. Since , this program has been supported by Health Quality Ontario HQO , which allows all participating hospitals in the province to collaborate and share their best practices.

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The ACS National Surgical Quality Improvement Program (ACS NSQIP®) is a nationally validated, risk-adjusted, outcomes-based program to measure and. Adv Surg. ; Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach.

P values of less than 0. All calculations were performed using GraphPad Prism version 6. Of these, only 1. Of the remaining 7, entries, only 4, entries contained data that allowed for survival analysis. General surgery cases encompassed major abdominal, endocrine, skin and soft tissue, and breast operations. Spinal operations were performed for decompression, biopsy, and stabilization. Operations were performed with palliative intent on 32 of the patients Within this group, general surgery procedures were performed on 13 patients By specialty, general surgery procedures were performed on 85 patients At 30 days, a total of 55 patients suffered a post-operative complication within the disseminated cancer group These included 15 patients within the palliative group and 40 patients within the non-palliative group The increased number of post-operative complications identified within the palliative group had no significant effects on survival.

Survival analysis was performed at numerous time points.

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The overall median survival for patients who underwent a palliative operation was days. A significant difference in post-operative mortality between these two groups became evident at 45 days Patients with advanced, incurable malignancy represent a small but unique subset within the surgical population.

Previous work has shown that routine outcome measures such as post-operative day morbidity and mortality are objective but rather incomplete outcome measures for palliative operations 2 , 5 , 6 , Although procedure-related complications certainly negatively impact quality of life, palliative series have consistently shown excellent patient satisfaction despite relatively high morbidity and mortality rates 1 , 5 , For the general surgery patient population, it is the most robust and reliable database available.

However, an inherent shortfall of the database is that it is arguably a population-based database that loses its power when analyzing more specific patient populations, such as the advanced cancer patient.

Comparison of palliative and non-palliative procedures could not establish that palliative patients have higher morbidity These differences did not reach statistical significance, which was most likely due to small patient numbers. This further demonstrates that calculations utilizing these data may approximate outcomes at 30 days, but cannot be representative of actual outcomes for this particular patient population given the limited number of cases collected.

Quality of Care

Unfortunately, a broader evaluation of palliative and non-palliative outcomes across the entire ACS-NSQIP database is not possible given the inability to determine palliative intent on a case-by-case basis across multiple institutions and innumerable providers. Health Systems.

British Columbia. Data generated from risk-adjusted and real-time online reports leads to the development of goals, quality improvement activities, and reduced health care costs.


The program is flexible and can customize the collected variables to meet the needs of participating sites. High-performing hospitals share their experiences and strategies with other participating hospitals. Innovative strategies involve multiple disciplines and front-line hospital staff in solving issues. NSQIP is the best methodology for measuring and reporting surgical quality and outcomes.

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Its results are the robust and comprehensive reflection of day surgical outcomes, standardized data definition, and real-time reports that monitor implemented strategies. There is also exceptional support from ACS to participating sites. Your feedback is important to us.