The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), created in 2004, is a nationally validated, risk–adjusted, outcomes-based program to measure and improve the quality of surgical care (1). The idea followed a concept that originated in the Veterans Affairs (VA) Hospital System in 1991 where it showed a 31% decrease in 30-day mortality(2). Recently, a three-year review showed that the ACS NSQIP improved risk-adjusted mortality in 66% of the participating hospitals and improved risk-adjusted morbidity in 82% of the member hospitals(3).
The program quantifies 30-day risk adjusted surgical outcomes among participating hospitals (more than 200 currently in the private sector). The outcomes data which is collected by a clinical nurse include all mortalities and 21 morbidity categories including cardiac, wound, respiratory and urinary tract.
The voluntary enrollment requires annual fees but provides comprehensive reports that allow the participating institutions to compare their surgical outcomes with those of other hospitals. The report does not provide outcomes by specific surgeon but that data is available if the institution wishes to perform internal reviews.
The institutions can select from a variety of options including: general and vascular surgery, multiple surgical subspecialties, the Centers for Medicare and Medicare Services Surgical Care Improvement Project (CMS SCIP) and the American College of Surgeons Bariatric Surgery Center Network Accreditation Program (ACS BSCN). In addition, low and high volume categories are available.
The success of the program seems to rely on the identification and diffusion of best practices from well-performing institutions to less efficient hospitals(2). Further study is needed to address: 1)what information is used and 2) how this information is used for quality improvement. In addition, current limitations of ACS NSQIP include its bias toward academic institutions and the general and vascular surgery fields.
1.ACS NSQIP website. https://acsnsqip.org/main/resources_information_packet.pdf (accessed Nov 18, 2009).
2.The NSQIP: A new frontier in surgery. Khuri-SF. Surgery;138:837-43.
3.Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program. An evaluation of all participating hospitals. Hall-BL et al. Ann Surg 2009;250:363-376.
Submitted by G Vinces