Quality improvement in gastrointestinal surgical oncology with American College of Surgeons National Surgical Quality Improvement Program

Donald J. Lucas, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

Abstract

Objective. To assess the impact of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participation on outcomes in gastrointestinal surgical oncology. Study design. A total of 6,076 resections for esophageal, gastric, pancreatic, hepatobiliary, and colorectal cancers at 316 hospitals from the 2006 to 2011 ACS NSQIP were examined. Thirty-day complication rates were analyzed longitudinally over time with the use of multiple regression; we adjusted for operation type and preoperative risk factors. Results. The procedure mix was 3% esophagectomy, 5% gastrectomy, 16% pancreatectomy, 4% hepatectomy, 63% colectomy, and 9% proctectomy. Median age was 66 years, and 52% were male, 41% were American Society of Anesthesiologists class 2, and 52% were American Society of Anesthesiologists 3. Depending on anatomic surgical site, 21-45% of patients experienced a postoperative complication and 1.1-4.4% died. The incidence of patients with any complication decreased from 28 to 24% over the period (risk-adjusted odds ratio 0.95 per year, 95% confidence interval 0.94-0.96). In contrast, there was no substantial change in risk-adjusted mortality over the period (odds ratio 1.03, 95% confidence interval 0.99-1.07). Conclusion. There was a decrease in complications over time for ACS NSQIP participants in gastrointestinal surgical oncology, but mortality did not decrease.

Original languageEnglish (US)
Pages (from-to)593-601
Number of pages9
JournalSurgery
Volume155
Issue number4
DOIs
StatePublished - 2014

ASJC Scopus subject areas

  • Surgery

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