Measuring Surgical Quality

Abstract Introduction Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background. To study the effect of different training backgrounds on practice pattern variations, we utilized the NSQIP (National Surgical Quality Improvement Database) database to assess hand surgery volumes and case variety by specialty. Materials and Methods NSQIP years 2008 to 2017 was queried with hand surgery current procedural terminology codes defined by the American Board of Orthopedic Surgery. Procedures were grouped according to type and specialty, and relative rates calculated. Hand society membership data were used to determine if procedural volume for each specialty in each category and overall contribution to the volume of hand surgery performed nationally was distributed in accordance with membership data. Results A total of 145,015 hand surgeries were performed; 13,267 (9.1%) by general surgeons, 28,402 (19.6%) by plastic surgeons, and 103,346 (71.3%) by orthopedic surgeons. Orthopedic surgeons performed significantly more bone, fracture, joint, and tendon cases. General surgeons and plastic surgeons performed higher than expected numbers of soft tissue coverage and cases overall with respective excesses of 183 and 22%. Conclusion Hand surgery is an available fellowship pathway from multiple residencies. Fellowship training does not level the field of real-world practice patterns. Residency training experiences significantly impact practice.

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Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1717828 ◽

2020 ◽

Author(s):

George A. Beyer ◽

Karan Dua ◽

Neil V. Shah ◽

Joseph P. Scollan ◽

Jared M. Newman ◽

...

Keyword(s):

Quality Improvement ◽

Upper Extremity ◽

Free Flap ◽

Quality Improvement Program ◽

Readmission Rates ◽

Improvement Program ◽

Surgical Quality ◽

Flap Transfer ◽

Free Flap Transfer ◽

Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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Faculty Opinions recommendation of Use of national surgical quality improvement program data as a catalyst for quality improvement.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1158906.620161 ◽

2009 ◽

Author(s):

Jason Campagna

Keyword(s):

Quality Improvement ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Program Data

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Faculty Opinions recommendation of What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons national surgical quality program improvement database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5890957.5881055 ◽

2010 ◽

Author(s):

Cate McIntosh

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Program Improvement ◽

Operative Procedures ◽

Care Hospital ◽

Surgical Quality ◽

Quality Program ◽

American College Of Surgeons

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Faculty Opinions recommendation of Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717980425.793471668 ◽

2013 ◽

Author(s):

Tomas Griebling

Keyword(s):

Quality Improvement ◽

Best Practices ◽

Preoperative Assessment ◽

American Geriatrics Society ◽

Quality Improvement Program ◽

Surgical Patient ◽

Improvement Program ◽

Surgical Quality ◽

American College Of Surgeons

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Faculty Opinions recommendation of American College of Surgeons National Surgical Quality Improvement Program assessment of risk factors for 30-day unplanned readmission in patients undergoing head and neck surgery requiring free tissue reconstruction.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736837135.793567720 ◽

2019 ◽

Author(s):

Giulio Cantu

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Head And Neck ◽

Neck Surgery ◽

Program Assessment ◽

Unplanned Readmission ◽

Improvement Program ◽

Surgical Quality ◽

American College Of Surgeons ◽

Tissue Reconstruction

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Are urologic surgeons performing robot-assisted radical prostatectomy at the University of Alberta meeting surgical quality performance benchmarks? The PROCURE-02 quality assurance study

Canadian Urological Association Journal ◽

10.5489/cuaj.6292 ◽

2019 ◽

Vol 14 (8) ◽

Author(s):

Ben Beech ◽

Graeme Follett ◽

Sunita Ghosh ◽

Jan K. Rudzinski ◽

Ryan McLarty ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Transfusion ◽

Injury Rate ◽

Rectal Injury ◽

Transfusion Rate ◽

Resection Rate ◽

Quality Performance ◽

Surgical Quality ◽

University Of Alberta ◽

R1 Resection

Introduction: Robot-assisted radical prostatectomy (RARP) is a standard of care primary treatment for men with clinically localized prostate cancer (CLPC). The 2010 Canadian Urological Association (CUA) consensus guideline examining surgical quality performance for radical prostatectomy suggested benchmarks for surgical performance. To date, no study has examined whether Canadian surgeons are achieving these benchmarks. We determined the proportion of University of Alberta (UA) urologic surgeons achieving the CUA surgical quality performance outcome (SQPO) benchmarks. Methods: A retrospective quality assurance analysis of prospectively collected data from the PROstate Cancer Urosurgery Repository of Edmonton (PROCURE) was performed. Men who underwent RARP for CLPC between September 2007 and May 2018 by one of seven surgeons were analyzed. SQPO were an unadjusted pT2–R1 resection rate <25%, blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. Descriptive statistics were used to determine the proportion of surgeons achieving the benchmarks. Results: Data were evaluable for 2821 men. Seven of 7 (100%) surgeons achieved a blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. However, only six of seven surgeons achieved an unadjusted pT2–R1 resection rate <25%; one surgeon had an unadjusted pT2–R1 resection rate of 27.9%. Limitations include the lack of centralized pathology review for surgical margin status by a dedicated genitourinary pathologist. Conclusions: UA surgeons are achieving the CUA SQPO benchmarks for blood transfusion, rectal injury, and perioperative mortality. However, not all UA urologists are achieving a pT2– R1 resection rate <25%. Surgical quality performance initiatives designed to improve cancer control may be warranted.

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