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The Use of Patient Registries in Breast Surgery

A Comparison of the Tracking Operations and Outcomes for Plastic Surgeons and National Surgical Quality Improvement Program Data Sets

Khavanin, Nima BS*; Gutowski, Karol A. MD, FACS; Hume, Keith M. MA; Simmons, Christopher J. BS; Mlodinow, Alexei S. BA*; Weiss, Michael MPH§; Mayer, Kristen E. BS*; Murphy, Robert X. Jr MD, MS§; Kim, John Y.S. MD, FACS*

doi: 10.1097/SAP.0000000000000383
Breast Surgery

Background The National Surgical Quality Improvement Program (NSQIP) and the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) registries gather outcomes for plastic surgery procedures. The NSQIP collects hospital data using trained nurses, and the TOPS relies on self-reported data. We endeavored to compare the TOPS and NSQIP data sets with respect to cohort characteristics and outcomes to better understand the strengths and weakness of each registry as afforded by their distinct data collection methods.

Study Design The 2008 to 2011 TOPS and NSQIP databases were queried for breast reductions and breast reconstructions. Propensity score matching identified similar cohorts from the TOPS and NSQIP databases. Shared 30-day surgical and medical complications rates were compared across matched cohorts.

Results The TOPS captured a significantly greater number of wound dehiscence occurrences (4.77%–5.47% vs 0.69%–1.17%, all P < 0.001), as well as more reconstructive failures after prosthetic reconstruction (2.82% vs 0.26%, P < 0.001). Medical complications were greater in NSQIP (P < 0.05). Other complication rates did not differ across any procedure (all P > 0.05).

Conclusions The TOPS and NSQIP capture significantly different patient populations, with TOPS’ self-reported data allowing for the inclusion of private practices. This self-reporting limits TOPS’ ability to identify medical complications; surgical complications and readmissions, however, were not underreported. Many surgical complications are captured by TOPS at a higher rate due to its broader definitions, and others are not captured by NSQIP at all. The TOPS and NSQIP provide complementary information with different strengths and weakness that together can guide evidence-based decision making in plastic surgery.

From the *Northwestern University, Feinberg School of Medicine, Chicago, IL; †Department of Plastic Surgery, The Ohio State University, Columbus, OH; ‡American Society of Plastic Surgeons, Chicago, IL; and §Lehigh Valley Health Network, Allentown, PA.

Received July 13, 2014, and accepted for publication, after revision, October 6, 2014.

Conflicts of interest and sources of funding: John Y.S. Kim receives research funding and is on the advisory board for the Musculoskeletal Transplant Foundation. Keith M. Hume and Christopher J. Simmons are employed by the American Society of Plastic Surgeons (ASPS). Robert X. Murphy, Jr, is the current president of the ASPS. All other authors have no relevant relationships to disclose.

Reprints: John Y.S. Kim, MD, FACS, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St Clair St, Galter Suite 19-250, Chicago, IL 60611. E-mail:

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Disclosure: The NSQIP and the hospitals participating in the NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors of this study.

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