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Meta-Analysis
. 2016 Jan 26;11(1):e0146254.
doi: 10.1371/journal.pone.0146254. eCollection 2016.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

Joshua Montroy  1 , Rodney H Breau  1   2   3 , Sonya Cnossen  1 , Kelsey Witiuk  1 , Andrew Binette  4 , Taylor Ferrier  4 , Luke T Lavallée  3 , Dean A Fergusson  1   2 , David Schramm  1   2   5
Affiliations
Meta-Analysis

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

Joshua Montroy et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study screening and selection flow chart.
NSQIP = National Surgical Quality Improvement Program; VASQIP = Veteran’s Affairs Surgical Quality Improvement Program.
Fig 2
Fig 2. Risk ratios (95% CI) and pooled estimates for superficial surgical site infections, pre vs. post-NSQIP implementation, stratified by intervention or no intervention to reduce infection.
Fig 3
Fig 3. Risk ratios (95% CI) and pooled estimates for deep surgical site infections pre vs. post-NSQIP implementation, stratified by intervention or no intervention to reduce infection.
Fig 4
Fig 4. Risk ratios (95% CI) and pooled estimates for organ/abdominal space infections pre vs. post-NSQIP implementation, stratified by intervention or no intervention to reduce infection.
Fig 5
Fig 5. Funnel plot of standard error vs. log risk ratio for superficial surgical site infections.
Fig 6
Fig 6. Funnel plot of standard error vs. log risk ratio for (b) deep surgical site infections.
Fig 7
Fig 7. Funnel plot of standard error vs. log risk ratio for organ/abdominal space infections.
See this image and copyright information in PMC

References

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