Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes

Guillamondegui, Oscar D.; Gunter, Oliver L.; Hines, Leonard; Martin, Barbara J.; Gibson, William; Clarke, P. Chris; Cecil, William T.; Cofer, Joseph B.

doi:10.1016/j.jamcollsurg.2011.12.012

« Previous Next »Journal of the American College of Surgeons
Volume 214, Issue 4 , Pages 709-714, April 2012

Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes

Presented at the Southern Surgical Association 123rd Annual Meeting, Hot Springs, VA, December 2011.

Oscar D. Guillamondegui, MD, MPH, FACS
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
- Tennessee Valley Healthcare System, Veteran's Affairs, Nashville, TN
Oliver L. Gunter, MD, FACS
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
Leonard Hines, MD, FACS
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
Barbara J. Martin, RN, MBA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
William Gibson, MD
- Premier Surgical Associates, Parkwest Medical Center, Knoxville, TN
P. Chris Clarke, RN, BSN
- Tennessee Hospital Association, Nashville, TN
William T. Cecil, MBA
- Tennessee Hospital Association, Nashville, TN
Joseph B. Cofer, MD, FACS
- Department of Surgery, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN
- Correspondence address: Joseph B Cofer, MD, FACS, Department of Surgery, Suite 401, 979 E Third St, Chattanooga, TN 37403

Received 5 December 2011; accepted 15 December 2011. published online 23 January 2012.

Background

Led by the Tennessee Chapter of the American College of Surgeons, in May 2008 a 10-hospital collaborative was formed between the Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation. We hypothesized that by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data, overall patient surgical outcomes would improve.

Study Design

All NSQIP data from the 10-hospital collaborative for the time periods January to December 2009 (period 1) and January to December 2010 (period 2) were collected. Data on 20 categories of postoperative complications and 30-day mortality were compared between periods. Complication comparisons and hospital costs associated with complications were calculated per 10,000 procedures. Statistical analysis was performed by Z-test.

Results

There were 14,205 total surgical cases in period 1 and 14,901 surgical cases in period 2. Between periods (per 10,000 cases) there were significant improvements in superficial surgical site infections (−19%, p = 0.0005), on ventilator longer than 48 hours (−15%, p = 0.012), graft/prosthesis/flap failure (−60%, p < 0.0001), acute renal failure (−25%, p = 0.023), and wound disruption (−34%, p = 0.011). Although mortality (per 10,000) was higher in period 2 (237.6 vs 232.3), no statistical difference was noted. Net costs avoided between these periods were calculated as $2,197,543 per 10,000 general and vascular surgery cases.

Conclusions

Data organization and scrutiny are the initial steps of process improvement. Participation in our regional surgical quality collaborative resulted in improved outcomes and reduced costs. Although the mechanisms for these changes are likely multifactorial, the collaborative establishes communication, process improvement, and frank discussion among the members as best practices are identified and shared and standardized processes are adopted.

Abbreviations and Acronyms: ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Program, DVT, deep venous thrombosis, ROI, return on investment, RR, relative risk, SSI, surgical site infection, TSQC, Tennessee Surgical Quality Collaborative