What is the Best Way to Track Surgical Complications? Comparing ACS-NSQIP vs. Traditional MM Rounds
Jacques X. Zhang, B.Sc.1, Julie Bedford, RN, MSN2, Diana Song, MD1, Douglas J. Courtemanche, MD, MS, FRCSC1, Marija Bucevska, MD1, Jugpal Arneja, MD, MBA, FRCSC1.
1University of British Columbia, Vancouver, BC, Canada, 2BC Children’s Hospital, Vancouver, BC, Canada.
Purpose. M&M rounds have played a traditional role in tracking complications. In recent years, ACS-NSQIP has gained popularity as a risk-adjusted means to address quality assurance/improvement. Herein, we report an analysis of the two methodologies for plastic surgery to determine the best way to manage quality.
Methods. With IRB approval, ACS-NSQIP and M&M data were extracted for 2012 and 2013 at a quaternary care institution. We analyzed raw complication rates and an equivalent comparison of rates after removing NSQIP-ineligible cases. We determined the concordance and discordance rate of both methodologies and classified complications by severity and type. Statistical analysis was performed on all samples.
Results. 1261 plastic surgery procedures were performed in the study period. Only 51.4% of cases were NSQIP-eligible. The overall complication rates of ACS-NSQIP (6.62%) and M&M (6.11%) were similar (p = 0.662). Comparing the two systems for ACS-NSQIP-eligible cases also yielded a similar rate (6.62% vs. 5.71%, p = 0.503). Although ACS-NSQIP and M&M track different types of occurrences, the concordance rate for M&M and ACS-NSQIP was 35.1% and 32.5% respectively and consisted mostly of major complications.
Conclusion. ACS-NSQIP is able to accurately track complications at a similar rate to M&M, although it samples only half of all procedures. Differences in definitions and purpose exist for each system, leading to low concordance rates. Although both systems offer value, both also have limitations. Due to the rigor of ACS-NSQIP, we recommend expansion of ACS-NSQIP to include currently excluded cases and an extension of the ACS-NSQIP study interval.
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