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...

Descripción completa

Detalles Bibliográficos
Autores principales: Montroy, Joshua, Breau, Rodney H., Cnossen, Sonya, Witiuk, Kelsey, Binette, Andrew, Ferrier, Taylor, Lavallée, Luke T., Fergusson, Dean A., Schramm, David
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