title: Can surgical performance benchmarking be generalized across multiple outcomes databases: a comparison of University HealthSystem Consortium and National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Surgeon's performance is tracked using patient outcomes databases. We compared data on patients undergoing laparoscopic cholecystectomy from 2 large databases with significant institutional overlap to see if either patient characteristics or outcomes were similar enough to accurately compare performance.
  
  
  METHODS
  Data from 2009 to 2011 were collected from University HealthSystem Consortium (UHC) and National Surgical Quality Improvement Program (NSQIP). UHC and NSQIP collect data from over 200 and 400 medical centers, respectively, with an overlap of 70. Patient demographics, pre-existing medical conditions, operative details, and outcomes were compared.
  
  
  RESULTS
  Fifty-six thousand one hundred ninety-seven UHC patients and 56,197 NSQIP patients met criteria. Groups were matched by age, sex, and pre-existing comorbidities. Outcomes for NSQIP and UHC differed, including mortality (.20% NSQIP vs .12% UHC; P < .0001), morbidity (2.0% vs 1.5%; P < .0001), wound infection (.07% vs .33%; P < .0001), pneumonia (.38% vs .75%; P < .0001), urinary tract infections (.62% vs .01%; P < .0001), and length of hospital stay (1.8 ± 7.5 vs 3.8 ± 3.7 days; P = .0004), respectively.
  
  
  CONCLUSIONS
  Surgical outcomes are significantly different between databases and resulting performance data may be significantly biased. A single unified national database may be required to correct this problem.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Bills
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Shostrom
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Boilesen
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: doleynik@unmc.edu.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D019985:Benchmarking; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002983:Clinical Competence; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D014481:United States
keywords: Cholecystectomy; Comparison; Database; Laparoscopy; Outcomes