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Original Investigation
February 3, 2015

Association of Hospital Participation in a Surgical Outcomes Monitoring Program With Inpatient Complications and Mortality

Author Affiliations
  • 1Department of Surgery, Mayo Clinic Arizona, Phoenix
  • 2Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Division, Phoenix, Arizona
  • 3Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota
  • 4University HealthSystem Consortium, Chicago, Illinois
  • 5Department of Health Systems Management, Rush University, Chicago, Illinois
JAMA. 2015;313(5):505-511. doi:10.1001/jama.2015.90
Abstract

Importance  Programs that analyze and report rates of surgical complications are an increasing focus of quality improvement efforts. The most comprehensive tool currently used for outcomes monitoring in the United States is the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP).

Objective  To compare surgical outcomes experienced by patients treated at hospitals that did vs did not participate in the NSQIP.

Design, Setting, and Participants  Data from the University HealthSystem Consortium from January 2009 to July 2013 were used to identify elective hospitalizations representing a broad spectrum of elective general/vascular operations in the United States. Data on hospital participation in the NSQIP were obtained through review of semiannual reports published by the ACS. Hospitalizations at any hospital that discontinued or initiated participation in the NSQIP during the study period were excluded after the date on which that hospital’s status changed. A difference-in-differences approach was used to model the association between hospital-based participation in NSQIP and changes in rates of postoperative outcomes over time.

Exposure  Hospital participation in the NSQIP.

Main Outcomes and Measures  Risk-adjusted rates of any complications, serious complications, and mortality during a hospitalization for elective general/vascular surgery.

Results  The cohort included 345 357 hospitalizations occurring in 113 different academic hospitals; 172 882 (50.1%) hospitalizations were in NSQIP hospitals. Hospitalized patients were predominantly female (61.5%), with a mean age of 55.7 years. The types of procedures performed most commonly in the analyzed hospitalizations were hernia repairs (15.7%), bariatric (10.5%), mastectomy (9.7%), and cholecystectomy (9.0%). After accounting for patient risk, procedure type, underlying hospital performance, and temporal trends, the difference-in-differences model demonstrated no statistically significant differences over time between NSQIP and non-NSQIP hospitals in terms of likelihood of complications (adjusted odds ratio, 1.00; 95% CI, 0.97-1.03), serious complications (adjusted odds ratio, 0.98; 95% CI, 0.94-1.03), or mortality (adjusted odds ratio, 1.04; 95% CI, 0.94-1.14).

Conclusions and Relevance  No association was found between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time within a large cohort of patients undergoing elective general/vascular operations at academic hospitals in the United States. These findings suggest that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.

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