Successful Implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the Private Sector: The Patient Safety in Surgery Study

Background:The Veterans Affairs ’ (VA) National Surgical Quality Improvement Program (NSQIP) has been associated with significant reductions in postoperative morbidity and mortality. We sought to determine if NSQIP methods and risk models were applicable to private sector (PS) hospitals and if implementation of the NSQIP in the PS would be associated with reductions in adverse postoperative outcomes. Methods:Data from patients (n = 184,843) undergoing major general or vascular surgery between October 1, 2001, and September 30, 2004, in 128 VA hospitals and 14 academic PS hospitals were used to develop prediction models based on VA patients only, PS patients only, and VA plus PS patients using logistic regression modeling, with measures of patient-related risk as the independent variables and 30-day postoperative morbidity or mortality as the dependent variable. Results:Nine of the top 10 predictors of postoperative mortality and 7 of the top 10 for postoperative morbidity were the same in the VA and PS models. The ratios of observed to expected mortality and morbidity in the PS hospitals based on a model using PS data only versus VA + PS data were nearly identical (correlation coefficient = 0.98). Outlier status of PS hospitals was concordant in 26 of 28 comparisons. Implementation of the NSQIP in PS hospitals was associated with statistically significant reductions in overall postoperative morbidity (8.7%, P = 0.002), surgical site infections (9.1%, P = 0.02), and renal complications (23.7%, P = 0.004). Conclusions:The VA NSQIP methods and risk models in general and vascular surgery were fully applicable to PS hospitals. Thirty-day postoperative morbidity in PS hospitals was reduced with the implementation of the NSQIP.

[1]  D. Waller How VA hospitals became the best. , 2006, Time.

[2]  O. Jonasson,et al.  The patient safety in surgery study: background, study design, and patient populations. , 2007, Journal of the American College of Surgeons.

[3]  S. Khuri,et al.  The NSQIP: a new frontier in surgery. , 2005, Surgery.

[4]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[5]  C A Marrin,et al.  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. , 1996, JAMA.

[6]  R. Depalma,et al.  Determinants of Long-Term Survival After Major Surgery and the Adverse Effect of Postoperative Complications , 2005, Annals of surgery.

[7]  K. Hammermeister,et al.  Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1998, Journal of the American College of Surgeons.

[8]  Gary J. Young,et al.  Validating risk-adjusted surgical outcomes: site visit assessment of process and structure1 , 1997 .

[9]  G. Young,et al.  Validating risk-adjusted surgical outcomes: site visit assessment of process and structure. National VA Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[10]  F. Grover,et al.  The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. , 1998, Annals of surgery.

[11]  W. Henderson,et al.  The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. , 2002, Archives of surgery.

[12]  J Gibbs,et al.  The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. , 1995, Journal of the American College of Surgeons.

[13]  L. Neumayer,et al.  Using the Veterans Administration National Surgical Quality Improvement Program to improve patient outcomes. , 2000, The Journal of surgical research.

[14]  Florence E. Turrentine,et al.  Use of national surgical quality improvement program data as a catalyst for quality improvement. , 2007, Journal of the American College of Surgeons.

[15]  Norman E. Breslow,et al.  The design and analysis of cohort studies , 1987 .

[16]  D. Stires How the VA healed itself. , 2006, Fortune.

[17]  F. Grover,et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[18]  G. Young,et al.  Best practices for managing surgical services: the role of coordination. , 1997, Health care management review.

[19]  W. Henderson,et al.  The National Surgical Quality Improvement Program in Non-Veterans Administration Hospitals: Initial Demonstration of Feasibility , 2002, Annals of surgery.

[20]  M P Charns,et al.  Patterns of coordination and clinical outcomes: a study of surgical services. , 1997, Health services research.