title: Quality improvement in gastrointestinal surgical oncology with American College of Surgeons National Surgical Quality Improvement Program.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  There was a decrease in complications over time for ACS NSQIP participants in gastrointestinal surgical oncology, but mortality did not decrease.
authors: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Donald J
authors: DJ
authors: Lucas
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000601:surgery*; D013502:General Surgery / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology; D015397:Program Evaluation / Q000639:trends*; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012044:Regression Analysis; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D014481:United States