Using the national surgical quality improvement program and the tennessee surgical quality collaborative to improve surgical outcomes

Oscar D. Guillamondegui, Oliver L. Gunter, Leonard Hines, Barbara J. Martin, William Gibson, P. Chris Clarke, William T. Cecil, Joseph B. Cofer

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Background: Led by the Tennessee Chapter of the American College of Surgeons, in May 2008 a 10-hospital collaborative was formed between the Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation. We hypothesized that by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data, overall patient surgical outcomes would improve. Study Design: All NSQIP data from the 10-hospital collaborative for the time periods January to December 2009 (period 1) and January to December 2010 (period 2) were collected. Data on 20 categories of postoperative complications and 30-day mortality were compared between periods. Complication comparisons and hospital costs associated with complications were calculated per 10,000 procedures. Statistical analysis was performed by Z-test. Results: There were 14,205 total surgical cases in period 1 and 14,901 surgical cases in period 2. Between periods (per 10,000 cases) there were significant improvements in superficial surgical site infections (-19%, p = 0.0005), on ventilator longer than 48 hours (-15%, p = 0.012), graft/prosthesis/flap failure (-60%, p < 0.0001), acute renal failure (-25%, p = 0.023), and wound disruption (-34%, p = 0.011). Although mortality (per 10,000) was higher in period 2 (237.6 vs 232.3), no statistical difference was noted. Net costs avoided between these periods were calculated as $2,197,543 per 10,000 general and vascular surgery cases. Conclusions: Data organization and scrutiny are the initial steps of process improvement. Participation in our regional surgical quality collaborative resulted in improved outcomes and reduced costs. Although the mechanisms for these changes are likely multifactorial, the collaborative establishes communication, process improvement, and frank discussion among the members as best practices are identified and shared and standardized processes are adopted.

Original languageEnglish (US)
Pages (from-to)709-714
Number of pages6
JournalJournal of the American College of Surgeons
Volume214
Issue number4
DOIs
StatePublished - Apr 1 2012

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Quality Improvement
Prosthesis Failure
Surgical Wound Infection
Costs and Cost Analysis
Mortality
Hospital Costs
Mechanical Ventilators
Practice Guidelines
Acute Kidney Injury
Blood Vessels
Communication
Transplants
Health
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery

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Using the national surgical quality improvement program and the tennessee surgical quality collaborative to improve surgical outcomes. / Guillamondegui, Oscar D.; Gunter, Oliver L.; Hines, Leonard; Martin, Barbara J.; Gibson, William; Clarke, P. Chris; Cecil, William T.; Cofer, Joseph B.

In: Journal of the American College of Surgeons, Vol. 214, No. 4, 01.04.2012, p. 709-714.

Research output: Contribution to journalArticle

Guillamondegui, Oscar D. ; Gunter, Oliver L. ; Hines, Leonard ; Martin, Barbara J. ; Gibson, William ; Clarke, P. Chris ; Cecil, William T. ; Cofer, Joseph B. / Using the national surgical quality improvement program and the tennessee surgical quality collaborative to improve surgical outcomes. In: Journal of the American College of Surgeons. 2012 ; Vol. 214, No. 4. pp. 709-714.
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AU - Hines, Leonard

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AU - Gibson, William

AU - Clarke, P. Chris

AU - Cecil, William T.

AU - Cofer, Joseph B.

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