Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality

JAMA. 2015 Feb 3;313(5):505-11. doi: 10.1001/jama.2015.90.


Importance: Programs that analyze and report rates of surgical complications are an increasing focus of quality improvement efforts. The most comprehensive tool currently used for outcomes monitoring in the United States is the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP).

Objective: To compare surgical outcomes experienced by patients treated at hospitals that did vs did not participate in the NSQIP.

Design, setting, and participants: Data from the University HealthSystem Consortium from January 2009 to July 2013 were used to identify elective hospitalizations representing a broad spectrum of elective general/vascular operations in the United States. Data on hospital participation in the NSQIP were obtained through review of semiannual reports published by the ACS. Hospitalizations at any hospital that discontinued or initiated participation in the NSQIP during the study period were excluded after the date on which that hospital's status changed. A difference-in-differences approach was used to model the association between hospital-based participation in NSQIP and changes in rates of postoperative outcomes over time.

Exposure: Hospital participation in the NSQIP.

Main outcomes and measures: Risk-adjusted rates of any complications, serious complications, and mortality during a hospitalization for elective general/vascular surgery.

Results: The cohort included 345,357 hospitalizations occurring in 113 different academic hospitals; 172,882 (50.1%) hospitalizations were in NSQIP hospitals. Hospitalized patients were predominantly female (61.5%), with a mean age of 55.7 years. The types of procedures performed most commonly in the analyzed hospitalizations were hernia repairs (15.7%), bariatric (10.5%), mastectomy (9.7%), and cholecystectomy (9.0%). After accounting for patient risk, procedure type, underlying hospital performance, and temporal trends, the difference-in-differences model demonstrated no statistically significant differences over time between NSQIP and non-NSQIP hospitals in terms of likelihood of complications (adjusted odds ratio, 1.00; 95% CI, 0.97-1.03), serious complications (adjusted odds ratio, 0.98; 95% CI, 0.94-1.03), or mortality (adjusted odds ratio, 1.04; 95% CI, 0.94-1.14).

Conclusions and relevance: No association was found between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time within a large cohort of patients undergoing elective general/vascular operations at academic hospitals in the United States. These findings suggest that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers / standards*
  • Adult
  • Aged
  • Female
  • Health Expenditures*
  • Humans
  • Male
  • Medicare / economics*
  • Middle Aged
  • Odds Ratio
  • Outcome Assessment, Health Care / methods*
  • Postoperative Complications / epidemiology*
  • Quality Improvement
  • Risk Adjustment
  • Surgical Procedures, Operative / mortality*
  • United States
  • Vascular Surgical Procedures