American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Peer-Reviewed Studies

American College of Surgeons National Surgical Quality Improvement Program

Studies showing the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) helps hospitals achieve measurable improvements in quality of care.

Improves Outcomes and Reduces Complications

A study published in the September 2009 issue of the Annals of Surgery evaluated 118 hospitals that began participating between 2005 and 2007. The study showed that hospitals participating in the ACS NSQIP program each prevented 250–500 complications annually. The study also concluded that hospitals of all types—large and small, urban and rural, teaching and non-teaching—improved their quality of care through ACS NSQIP and the hospitals that were poorer performers when they joined ACS NSQIP achieved the greatest quality improvement.

Hall BL., et al. Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2009;250:363-376.

Reduces Morbidity

A study published in the August 2008 issue of Annals of Surgery evaluated patients undergoing general or vascular surgery in 128 Veterans Affairs (VA) medical centers and 14 private sector hospitals between 2001 and 2004. The study showed that the implementation of ACS NSQIP in private sector hospitals was associated with a reduction in morbidity following major and general vascular surgery similar to what had previously been observed for eight surgical specialties in the VA.

Khuri S, Henderson W, Daley J, et al. Successful Implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the Private Sector: The Patient Safety in Surgery Study. Ann Surg. 2008;248:329-336.

ACS NSQIP Data ReliabilityUses Highly Effective Training and Auditing Procedures

A study published in the January 2010 issue of the Journal of the American College of Surgeons evaluated the data quality and inter-rater reliability in ACS NSQIP for the 2005 through 2008 calendar years. The study determined the training and audit procedures for hospitals participating in ACS NSQIP are highly effective in collecting data. Audit results show that data have been reliable since the program’s inception and that reliability has improved every year.

Shiloach M, Frencher S, Steeger J, et al. Toward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210:6-16.

Includes Validated Measurements

A study published in the Journal of the American College of Surgeons assessed the validity of risk-adjusted surgical morbidity and mortality rates as measures of quality of care. The study confirmed an association between the risk-adjusted adverse outcomes of surgical mortality and postoperative morbidity.

Daley J, Forbes M, Young G, et al. Validating Risk-Adjusted Surgical Outcomes: Site Visit Assessment of Process and Structure. J Am Coll Surg. 1997;185:341-351.

Uses Robust Clinical Data

A 2008 study in Surgery compared ACS NSQIP’s risk-adjusted, clinical, 30-day outcomes database with the administrative data collected in the University Health Consortium (UHC) program. Researchers found ACS NSQIP uncovered 26 percent more complications than the UHC program. Among surgical site infections (SSI), 11 percent of patients were reported to have had an SSI in the ACS NSQIP database while only one percent in the UHC.

Missed ComplicationsIn 2009, a study in the American Journal of Medical Quality directly compared the UHC database and the NSQIP dataset, finding that ACS NSQIP data was more highly correlated to outcomes. The study found UHC’s program “missed or misclassified” several major complications, due to its reliance on administrative data.

Steinberg S, Popa M, et al. Comparison of Risk Adjustment Methodologies in Surgical Quality Improvement. Surgery. 2008;144:662-669.

Davenport DL, Holsapple CW, Conigliaro J. Assessing Surgical Quality Using Administrative and Clinical Data Sets: A Direct Comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program Data Set. Am J Med Qual. 2009, Sep-Oct;24(5):395-402.

ACS Committee on Trauma

Studies show American College of Surgeon’s Committee on Trauma (ACS COT) has achieved improvements in all phases of the care of injured patients and in prevention of injuries through programs to measure and benchmark clinically valid data, support regional trauma systems, and create national guidelines and provide verification of Levels I-IV trauma centers.

Reduces Mortality

Risk of DeathA study published in the Jan. 26, 2006, issue of The New England Journal of Medicine evaluated the records of patients (ages 18 to 84) with moderate to severe injuries, comparing the mortality outcomes of those treated in Level I trauma centers in 18 hospitals to those treated in non-trauma centers at 51 hospitals. After adjustment for differences in the case mix, the National Study on the Costs and Outcomes of Trauma (NSCOT), showed that overall risk of death was 25 percent lower when care was provided at a Level I trauma center than when it was provided at a non-trauma center. Besides demonstrating improved survivability in Level I trauma centers, the study also supports the case for continued efforts at regionalized trauma systems.

The trauma verification process has been effective in driving significant quality improvements at trauma centers around the country. In the first five years of the program, 54 of 124 reviewed hospitals had criteria deficiencies, most commonly due to their performance improvement (PI) programs. Most hospitals corrected their deficiencies, underwent a second review, and were verified as trauma centers.

MacKenzie, EJ, et al. A National Evaluation of the Effect of Trauma-Center Care on Mortality. N Engl J Med. 2006 Jan 26;354(4):366-78.

Mitchell FL, et al. American College of Surgeons Verification/Consultation Program: Analysis of Unsuccessful Verification Reviews. J Trauma. 1994;37:557-562.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

A study comparing bariatric surgery outcomes for Medicare and Non-Medicare patients has shown that patient outcomes are better at accredited bariatric centers designated under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Better Outcomes

A 2010 study showed that Medicare patients who underwent bariatric surgery after the CMS decision that made Level I centers a prerequisite for reimbursement benefited from a shorter length of stay (3.5 vs 3.1 days, P < .001) and lower overall complication rates (12.2% vs 10.0%, P < .001), with no significant differences in the in-hospital mortality rates (0.28% vs 0.20%).

Nguyen NT, Hohmann S, Slone J, Varela E, Smith BR, Hoyt D. Improved Bariatric Surgery Outcomes for Medicare Beneficiaries After Implementation of the Medicare National Coverage Determination. Arch Surg. 2010;145(1):72-78.