Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

BackgroundThe American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery.Study DesignA systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI).ResultsEleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program.ConclusionsThese data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

背景：美国外科医师学会的国家手术质量改进计划（NSQIP）系北美地区首个经国家验证、风险调整、以结果为基础的测量与比较手术护理质量的项目。参与该计划或许能降低与手术相关的不良事件发生率。
研究设计：本研究对文献进行了系统综述。通过MedLine、EMBASE和PubMed数据库检索与NSQIP相关的文献。提取患者特征、干预措施及主要结局指标。干预措施包括参与NSQIP以及监测个体站点概要报告，是否实施质量改进计划。关注的结局为围手术期不良事件变化及死亡率，以汇总风险比（pRR）和95%置信区间（CI）表示。
结果：纳入了11篇报道35个医疗机构的研究。其中9项（82%）的研究实施了质量改进计划。未实施质量改进计划的中心在浅表（pRR 0.81；95% CI 0.72–0.91）、深部（pRR 0.82；95% CI0.64–1.05）及器官间隙（pRR 1.15；95% CI 0.96–1.37）感染方面仅观察到轻微改善。然而，报告了正式干预措施以预防和治疗感染的中心观察到显著改善（浅表pRR 0.55，95% CI 0.39–0.77；深部pRR 0.61，95% CI 0.50–0.75，器官间隙pRR 0.60，95% CI 0.50–0.71）。评估其他不良事件的研究指出，在参与NSQIP并实施正式质量改进计划后，不良事件发生率有所下降。
结论：这些数据表明，NSQIP在降低手术发病率方面是有效的。实施针对特定发病率降低的正式质量改进计划的中心，在手术质量改善方面似乎更为显著。