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

NSQIP in the Literature

A PubMed search of “NSQIP” yields in excess of 1,100 publications through June 30, 2016, with 350 new publications appearing annually.

Visit PubMed for a complete list of ACS NSQIP publications.

Among the more than 1,100 papers with “NSQIP” appearing, there are reports conducted on data spanning the hospital to national spectrum, describing quality successes using ACS NSQIP data, as well as failures to identify unique benefits. This literature requires careful and detailed analysis with respect to research design, analytic strategies, and conclusions drawn.

Selected Bibliography

The following papers are some of those that are: (1) most important in understanding the history of NSQIP - from its inception in the VA system through contemporary analytic methods; or (2) provide the most technically comprehensive evaluations of the impact NSQIP on improving surgical outcomes. Papers critical of ACS NSQIP have been included.


Khuri SF, Henderson WG, Daley J, Jonasson O, Jones RS, Campbell DA Jr, Mentzer RM Jr, Neumayer L, Hammermeister K, Mosca C, Healey N. Successful implementation of the Department of Veterans Affairs' National Surgical Quality Improvement Program in the private sector: The Patient Safety in Surgery study. Annals of Surgery, 2008; 248:329-336.


Hall BL, Hamilton BH, Richards K., Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: An evaluation of all participating hospitalsAnnals of Surgery, 2009; 250:363-376.


Ingraham A M, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: The American College of Surgeons National Surgical Quality Improvement Program approach. Advances in of Surgery, 2010; 44:251-267.


Lawson EH, Louie R, Zingmond DS, Brook RH, Hall BL, Han L, Ko CY. A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical outcomesAnnals of Surgery, 2013; 256:973-981.


Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, Liu Y, Kraemer K, Meng X, Merkow R, Chow W, Matel B, Richards K, Hart AJ, Dimick JB, Hall BL. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: Patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. Journal of the American College of Surgeons, 2013; 217:336-346.

Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP Surgical Risk Calculator: A decision aide and informed consent tool for patients and surgeons. Journal of the American College of Surgeons, 2013; 217:833-842.


Maggard-Gibbons M. The use of report cards and outcome measurements to improve the safety of surgical care: The American College of Surgeons National Surgical Quality Improvement Program. BMJ Quality and Safety, 2014, 23:589-599.


Ko CY, Hall BL, Hart AJ, Cohen ME, Hoyt DB. The American College of Surgeons National Surgical Quality Improvement Program: Achieving better and safer quality. The Joint Commission Journal on Quality and Patient Safety, 2015; 41:199-204.

Huffman KM, Cohen ME, Ko CY, Hall BL. A comprehensive evaluation of statistical reliability in ACS NSQIP profiling models. Annals of Surgery, 2015; 261:1108-1113

Hall BL, Huffman KM, Hamilton BH, Paruch JL, Zhou L. Richards KE, Cohen ME, Ko CY. Profiling individual surgeon performance using information from a high-quality clinical registry: Opportunities and limitations. Journal of the American College of Surgeons 2015; 221:901-913.

Etzioni DA, Wasif N, Dueck AC,Cima, RR, Hohmann SF, Naessens JM, Mathur AK, Habermann EB.  Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA, 2015; 313:505-511.

Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA, 2015; 313:496-504.

Berwick, DM. Measuring surgical outcomes for improvement: Was Codman wrong? JAMA, 2015; 313:469-470.

Woodall WH, Fogel SL, Steiner SH. The monitoring and improvement of surgical-outcome qualityJournal of Quality Technology, 2015; 42:383-399.


Liu Y, Cohen ME, Hall BL, Ko CY, Bilimoria KY. Evaluation and enhancement of calibration in the ACS NSQIP Surgical Risk Calculator. Journal of the American College of Surgeon, (epub ahead of print).

Cohen ME, Liu Y, Huffman KM, Ko CY, Hall BL. On-demand reporting of risk-adjusted and smoothed rates for quality improvement in ACS NSQIP.  Annals of Surgery, (epub ahead of print).

Cohen, ME, Liu Y, Ko CY, Hall BL. Improved surgical outcomes for ACS NSQIP hospitals over time: Evaluation of hospital cohorts with up to 8 years of participation. Annals of Surgery, 2016; 263:267-273.

Cohen ME, Hall BL, Liu Y, Ko CY. Evaluating the benefits of ACS-NSQIP. Annals of Surgery, 2016 (epub ahead of print).

Montroy J, Breau RH, Cnossen S, Witiuk K, Binette A, Ferrier T, Lavallee LT, Fergusson DA, Schramm D.  Change in adverse events after enrolment in the National Surgical Quality Improvement Program: A systematic review and meta-analysis. PLoS One, January 26, 2016.