Did we prioritize quality improvement in general surgery

Time for a focus on outcomes and enhanced recovery care plans?

Byron D. Hughes, Eric Sieloff, Hemalkumar Mehta, Anthony J. Senagore

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. Methods: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each. Results: Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005. Conclusion: Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. NSQIP is a high-quality instrument to assess morbidity and mortality across general surgery procedures. Our NSQIP derived data demonstrates that there are several procedures with disproportionate adverse events in the field of general surgery—colectomy, outpatient cholecystectomy and ventral hernia repair. Redeploying solution-driven efforts toward these specific procedures is essential.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Quality Improvement
Cholecystectomy
Outpatients
Colectomy
Mortality
Current Procedural Terminology
Ventral Hernia
Morbidity
Herniorrhaphy
Incidence

Keywords

  • ERP
  • General surgery
  • NSQIP

ASJC Scopus subject areas

  • Surgery

Cite this

Did we prioritize quality improvement in general surgery : Time for a focus on outcomes and enhanced recovery care plans? / Hughes, Byron D.; Sieloff, Eric; Mehta, Hemalkumar; Senagore, Anthony J.

In: American Journal of Surgery, 01.01.2018.

Research output: Contribution to journalArticle

@article{f2e81f65d88a4c9e979056073627a151,
title = "Did we prioritize quality improvement in general surgery: Time for a focus on outcomes and enhanced recovery care plans?",
abstract = "Background: In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. Methods: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each. Results: Ten procedure groups accounted for 80{\%} of adverse events. Colectomy ranked the highest for adverse events (34{\%}), readmissions (27{\%}) and mortality rates (45.8{\%}). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224{\%} since 2005. Conclusion: Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. NSQIP is a high-quality instrument to assess morbidity and mortality across general surgery procedures. Our NSQIP derived data demonstrates that there are several procedures with disproportionate adverse events in the field of general surgery—colectomy, outpatient cholecystectomy and ventral hernia repair. Redeploying solution-driven efforts toward these specific procedures is essential.",
keywords = "ERP, General surgery, NSQIP",
author = "Hughes, {Byron D.} and Eric Sieloff and Hemalkumar Mehta and Senagore, {Anthony J.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.amjsurg.2018.10.022",
language = "English (US)",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Did we prioritize quality improvement in general surgery

T2 - Time for a focus on outcomes and enhanced recovery care plans?

AU - Hughes, Byron D.

AU - Sieloff, Eric

AU - Mehta, Hemalkumar

AU - Senagore, Anthony J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. Methods: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each. Results: Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005. Conclusion: Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. NSQIP is a high-quality instrument to assess morbidity and mortality across general surgery procedures. Our NSQIP derived data demonstrates that there are several procedures with disproportionate adverse events in the field of general surgery—colectomy, outpatient cholecystectomy and ventral hernia repair. Redeploying solution-driven efforts toward these specific procedures is essential.

AB - Background: In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. Methods: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each. Results: Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005. Conclusion: Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. NSQIP is a high-quality instrument to assess morbidity and mortality across general surgery procedures. Our NSQIP derived data demonstrates that there are several procedures with disproportionate adverse events in the field of general surgery—colectomy, outpatient cholecystectomy and ventral hernia repair. Redeploying solution-driven efforts toward these specific procedures is essential.

KW - ERP

KW - General surgery

KW - NSQIP

UR - http://www.scopus.com/inward/record.url?scp=85055673049&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055673049&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2018.10.022

DO - 10.1016/j.amjsurg.2018.10.022

M3 - Article

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

ER -