Driving perioperative nutrition quality improvement processes forward!

Evidence supporting the important role of nutrition therapy in surgical patients has evolved, with several randomized trials and meta-analyses of randomized trials clearly demonstrating benefits. Despite this evidence, surgeons and anesthesiologists have been slow to adopt recommended practices, and the traditional dogma of delaying the initiation of and restricting the amount of nutrition during the postoperative period persists. Consequently, the nutrition therapy received by surgical patients remains suboptimal; thus, patients suffer worse clinical outcomes.

Risk-adjusted hospital outcomes for children's surgery.

Unlabelled: BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance.

Methods: Participating institutions included children's units within general hospitals and free-standing children's hospitals.

Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives.

Importance: Surgical site infections (SSIs) are the focus of numerous quality improvement initiatives because they are a common and costly cause of potentially preventable patient morbidity. Superficial and deep/organ-space SSIs differ in terms of anatomical location and clinical severity.

Objective: To identify risk factors that are uniquely predictive of superficial vs deep/organ-space SSIs occurring after colectomy procedures.

Effect of cancer surgery complexity on short-term outcomes, risk predictions, and hospital comparisons.

Background: Concern exists that oncologic surgical complexity is not adequately captured by the primary procedure code alone. Our objectives were to characterize the association between secondary procedures and 30-day outcomes, evaluate the effect of surgical complexity on risk predictions, and assess the influence of surgical complexity on hospital-quality comparisons.

Study Design: Patients who underwent colon, rectal, or pancreatic resection for cancer (2007-2011) were identified from the American College of Surgeons NSQIP.

Reliability of evaluating hospital quality by colorectal surgical site infection type.

Objective: To determine whether risk-adjusted colorectal SSI rates are statistically reliable as hospital quality measures.

Background: Policymakers use surgical site infections (SSI) for public reporting of hospital quality and pay-for-performance because they are a relatively common and costly cause of patient morbidity.

Methods: Patients who underwent a colorectal procedure in 2009 were identified from the American College of Surgeons National Surgical Quality Improvement Program.

Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) collects detailed clinical data from participating hospitals using standardized data definitions, analyzes these data, and provides participating hospitals with reports that permit risk-adjusted comparisons with a surgical quality standard. Since its inception, the ACS NSQIP has worked to refine surgical outcomes measurements and enhance statistical methods to improve the reliability and validity of this hospital profiling. From an original focus on controlling for between-hospital differences in patient risk factors with logistic regression, ACS NSQIP has added a variable to better adjust for the complexity and risk profile of surgical procedures (procedure mix adjustment) and stabilized estimates derived from small samples by using a hierarchical model with shrinkage adjustment.

Differences in patients, surgical complexity, and outcomes after cancer surgery at National Cancer Institute-designated cancer centers compared to other hospitals.

Background: Interest in comparing hospital surgical quality continues to increase, particularly with respect to examining certain hospital designations such as National Cancer Institute-designated Cancer Centers (NCI-CC). Our objectives were to compare patients, surgical complexity, and risk-adjusted 30-day outcomes following major cancer surgery at NCI-CC versus non-NCI centers.

Methods: From the American College of Surgeons National Surgical Quality Improvement Program, patients were identified who underwent colorectal, pancreatic, or esophagogastric resection for cancer (2007-2011).

Association between occurrence of a postoperative complication and readmission: implications for quality improvement and cost savings.

Objective: To estimate the effect of preventing postoperative complications on readmission rates and costs.

Background: Policymakers are targeting readmission for quality improvement and cost savings. Little is known regarding mutable factors associated with postoperative readmissions.

Effect of including cancer-specific variables on risk-adjusted hospital surgical quality comparisons.

Background: Quality initiatives are increasingly focusing on the quality of oncologic surgery. However, there is concern that a lack of cancer-specific variables may make risk-adjusted hospital quality comparisons inadequate. Our objective was to assess whether hospital quality rankings for cancer surgery are influenced by the addition of cancer-specific variables to the risk-adjusted models.

American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report.

Purpose: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons.

Methods: Data from the first full year of beta-phase NSQIP-P were analyzed.

Validity and feasibility of the american college of surgeons colectomy composite outcome quality measure.

Objective: To develop a reliable, robust, parsimonious, risk-adjusted 30-day composite colectomy outcome measure.

Background: A fundamental aspect in the pursuit of high-quality care is the development of valid and reliable performance measures in surgery. Colon resection is associated with appreciable morbidity and mortality and therefore is an ideal quality improvement target.

Composite measures for profiling hospitals on surgical morbidity.

Context: Although risk-adjusted morbidity is widely used as a surgical quality indicator, it may not always be a reliable indicator of hospital quality. In this study, we assess the value of a novel composite measure for improving the reliability of hospital morbidity rankings.

Design, Setting, And Patients: Using data from the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP), we studied all patients undergoing 4 surgical procedures (2008-2009): colectomy, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass surgery.

Effect of including cancer-specific variables on models examining short-term outcomes.

Background: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) generally has not collected cancer-specific variables. Because increasing numbers of studies are using ACS NSQIP data to study cancer surgery, the objectives of the current study were 1) to examine differences between existing ACS NSQIP variables and cancer registry variables, and 2) to determine whether the addition of cancer-specific variables improves modeling of short-term outcomes.

Methods: Data from patients in the ACS NSQIP and National Cancer Data Base (NCDB) who underwent colorectal resection for cancer were linked (2006-2008).

Short-term outcomes after esophagectomy at 164 American College of Surgeons National Surgical Quality Improvement Program hospitals: effect of operative approach and hospital-level variation.

Hypothesis: When assessing the effect of operative approach on outcomes, it may be less relevant whether a transhiatal or an Ivor Lewis esophagectomy was performed and may be more important to focus on patient selection and the quality of the hospital performing the operation.

Design: Observational study.

Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.

Hospital morbidity rankings and complication severity in vascular surgery.

Introduction: The American College of Surgeons National Surgical Quality Improvement Program ranks hospitals according to risk-adjusted rates of postoperative complications. However, this approach does not consider the severity or number of complications that occurred. We sought to determine whether incorporating this information would alter hospital rankings.

Linkage of a clinical surgical registry with Medicare inpatient claims data using indirect identifiers.

Background: A variety of data sources are available for measuring the quality of health care. Linking records from different sources can create unique and powerful databases that can be used to evaluate clinically relevant questions and direct health care policy. The objective of this study was to develop and validate a deterministic linkage algorithm that uses indirect patient identifiers to reliably match records from a surgical clinical registry with Medicare inpatient claims data.

A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications.

Objectives: To compare the recording of 30-day postoperative complications between a national clinical registry and Medicare inpatient claims data and to determine whether the addition of outpatient claims data improves concordance with the clinical registry.

Background: Policymakers are increasingly discussing use of postoperative complication rates for value-based purchasing. There is debate regarding the optimal data source for such measures.

Association between postoperative complications and reoperation for patients undergoing geriatric surgery and the effect of reoperation on mortality.

Elderly patients have greater risk for postoperative adverse events (PAEs). The study examines the rates of reoperation, the association between PAEs and reoperation, and the effect of reoperation on mortality for patients 65 years of age or older undergoing colorectal resections (CRRs), pancreatic resections (PRs), and lower extremity bypass (LEB) in 2010 American College of Surgeons National Surgical Quality Improvement Program. The models evaluating associations between reoperation and preoperative factors, PAEs, and mortality were developed using multiple logistic regression.

The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures.

Objective: To summarize the findings of methodological studies on the RAND/University of California Los Angeles (RAND/UCLA) appropriateness method, which was developed to assess if variation in the use of surgical procedures is because of overuse and/or underuse.

Study Design And Setting: A MEDLINE literature search was performed. Studies were included if they assessed the reliability or validity of the RAND/UCLA appropriateness method for a surgical procedure or the effect of altering panelist composition or eliminating in-person discussion between rating rounds.

Risk of morbidity and mortality following hepato-pancreato-biliary surgery.

Introduction: Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS-NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery.