Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis
BACKGROUND: The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportun...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727780/ https://www.ncbi.nlm.nih.gov/pubmed/26812596 http://dx.doi.org/10.1371/journal.pone.0146254 |
_version_ | 1782412021155758080 |
---|---|
author | Montroy, Joshua Breau, Rodney H. Cnossen, Sonya Witiuk, Kelsey Binette, Andrew Ferrier, Taylor Lavallée, Luke T. Fergusson, Dean A. Schramm, David |
author_facet | Montroy, Joshua Breau, Rodney H. Cnossen, Sonya Witiuk, Kelsey Binette, Andrew Ferrier, Taylor Lavallée, Luke T. Fergusson, Dean A. Schramm, David |
author_sort | Montroy, Joshua |
collection | PubMed |
description | BACKGROUND: The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. STUDY DESIGN: A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). RESULTS: Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. CONCLUSIONS: These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. |
format | Online Article Text |
id | pubmed-4727780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-47277802016-02-03 Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis Montroy, Joshua Breau, Rodney H. Cnossen, Sonya Witiuk, Kelsey Binette, Andrew Ferrier, Taylor Lavallée, Luke T. Fergusson, Dean A. Schramm, David PLoS One Research Article BACKGROUND: The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. STUDY DESIGN: A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). RESULTS: Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. CONCLUSIONS: These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. Public Library of Science 2016-01-26 /pmc/articles/PMC4727780/ /pubmed/26812596 http://dx.doi.org/10.1371/journal.pone.0146254 Text en © 2016 Montroy et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Montroy, Joshua Breau, Rodney H. Cnossen, Sonya Witiuk, Kelsey Binette, Andrew Ferrier, Taylor Lavallée, Luke T. Fergusson, Dean A. Schramm, David Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title | Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title_full | Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title_fullStr | Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title_full_unstemmed | Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title_short | Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis |
title_sort | change in adverse events after enrollment in the national surgical quality improvement program: a systematic review and meta-analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727780/ https://www.ncbi.nlm.nih.gov/pubmed/26812596 http://dx.doi.org/10.1371/journal.pone.0146254 |
work_keys_str_mv | AT montroyjoshua changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT breaurodneyh changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT cnossensonya changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT witiukkelsey changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT binetteandrew changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT ferriertaylor changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT lavalleeluket changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT fergussondeana changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis AT schrammdavid changeinadverseeventsafterenrollmentinthenationalsurgicalqualityimprovementprogramasystematicreviewandmetaanalysis |