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Improved Surgical Outcomes for ACS NSQIP Hospitals Over Time

Evaluation of Hospital Cohorts With up to 8 Years of Participation

Cohen, Mark E. PhD; Liu, Yaoming PhD; Ko, Clifford Y. MD, MS, MSHS, FACS; Hall, Bruce L. MD, PhD, MBA, FACS

doi: 10.1097/SLA.0000000000001192

Background: The American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) surgical quality feedback models are recalibrated every 6 months, and each hospital is given risk-adjusted, hierarchical model, odds ratios that permit comparison to an estimated average NSQIP hospital at a particular point in time. This approach is appropriate for “relative” benchmarking, and for targeting quality improvement efforts, but does not permit evaluation of hospital or program-wide changes in quality over time. We report on long-term improvement in surgical outcomes associated with participation in ACS NSQIP.

Study Design: ACS NSQIP data (2006–2013) were used to create prediction models for mortality, morbidity (any of several distinct adverse outcomes), and surgical site infection (SSI). For each model, for each hospital, and for year of first participation (hospital cohort), hierarchical model observed/expected (O/E) ratios were computed. The primary performance metric was the within-hospital trend in logged O/E ratios over time (slope) for mortality, morbidity, and SSI.

Results: Hospital-averaged log O/E ratio slopes were generally negative, indicating improving performance over time. For all hospitals, 62%, 70%, and 65% of hospitals had negative slopes for mortality, morbidity, and any SSI, respectively. For hospitals currently in the program for at least 3 years, 69%, 79%, and 71% showed improvement in mortality, morbidity, and SSI, respectively. For these hospitals, we estimate 0.8%, 3.1%, and 2.6% annual reductions (with respect to prior year's rates) for mortality, morbidity, and SSI, respectively.

Conclusions: Participation in ACS NSQIP is associated with reductions in adverse events after surgery. The magnitude of quality improvement increases with time in the program.

*Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA

VA Greater Los Angeles Healthcare System, Los Angeles, CA

§Department of Surgery at Washington University, St Louis, MO

||Center for Health Policy and the Olin Business School at Washington University, St Louis, MO

John Cochran Veterans Affairs Medical Center, and BJC Healthcare, St Louis, MO.

Reprints: Mark E. Cohen, PhD, Division of Research and Optimal Patient Care, American College of Surgeons, 633 N Saint Clair St, 22nd Floor, Chicago, IL 60611. E-mail:

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