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 Scopus citations


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
StateAccepted/In press - Jan 1 2018



  • ERP
  • General surgery

ASJC Scopus subject areas

  • Surgery

Cite this