Nationwide 30-Day Surgical Outcomes in Korea: An Interim Analysis of the Korean Quality Improvement Platform in Surgery

Hyeong Seok Kim; Bang Wool Eom; Oh Chul Kwon; Hye Rim Seo; Jeong Ho Song; Juhan Lee; In-Seob Lee; Ji Won Park; In Woong Han; Woo Yong Lee; K-QIPS Investigators

doi:10.1097/XCS.0000000000001867

Nationwide 30-Day Surgical Outcomes in Korea: An Interim Analysis of the Korean Quality Improvement Platform in Surgery

J Am Coll Surg. 2026 Feb 23. doi: 10.1097/XCS.0000000000001867. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
² Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
³ MDB Inc., Seoul, Korea.
⁴ The Korean Surgical Research Foundation, Seoul, Korea.
⁵ Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
⁶ Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
⁷ Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁸ Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

PMID: 41728845
DOI: 10.1097/XCS.0000000000001867

Abstract

Background: National surgical registries such as the American College of Surgeons National Surgical Quality Improvement Program and Japan's National Clinical Database have shown that structured, risk-adjusted outcome monitoring improves surgical quality. However, no comparable nationwide registry has been reported in Korea.

Methods: This interim analysis of the Korean Quality Improvement Platform in Surgery (K-QIPS) included 42,943 cases from 45 hospitals (2013-2023) covering gastric, colorectal, hepatic, pancreatic surgery, and kidney transplantation. Outcomes were 30-day complications, major complications (Clavien-Dindo ≥ III), and mortality. Hierarchical generalized linear mixed models generated risk-adjusted estimates, accounting for patient- and procedure-level factors and stabilizing results for low-volume centers.

Results: The 30-day complication, major complication, and mortality rates were 38.7%, 12.7%, and 0.59%, respectively. Mortality was highest after pancreatic surgery (1.17%) and lowest after gastric surgery (0.16%). Pneumonia occurred in 1.74% of cases and surgical site infection (SSI) in 4.0%. Risk-adjusted benchmarking of a representative institution (H037) classified pneumonia (adjusted odds ratio [OR], 0.67) as "as expected," whereas SSI (adjusted OR, 0.15) and mortality (adjusted OR, 0.55) were classified as "exemplary." Multivariable analyses confirmed established risk factors: colorectal surgery and higher wound class predicted SSI, chronic pulmonary disease and emergency surgery predicted pneumonia, and higher American Society of Anesthesiologists class and age predicted mortality.

Conclusions: K-QIPS demonstrates the feasibility of a nationwide, risk-adjusted surgical registry in Korea and establishes a benchmark for institutional feedback. As data collection nears completion (target: 219,200 cases), future efforts will focus on subspecialty-specific models, patient-level risk calculators, and integration with AI-driven clinical decision support systems.