title: Can the national surgical quality improvement program provide surgeon-specific outcomes?
abstract: BACKGROUND
  Efforts to improve the quality of surgical care and reduce morbidity and mortality have resulted in outcomes reporting at the service and institutional level. Surgeon-specific outcomes are not readily available.
  
  
  OBJECTIVE
  The aim of this study is to compare surgeon-specific outcomes from the National Surgical Quality Improvement Program and 100% capture institutional quality data.
  
  
  METHODS
  We conducted a cohort study evaluating institutional and surgeon-specific outcomes following colorectal surgery procedures at 1 institution over 5 years.
  
  
  METHODS
  All patients who underwent an operation by a colorectal surgeon at Lahey Hospital & Medical Center from January 1, 2008 through December 31, 2012 were identified.
  
  
  METHODS
  Thirty-day mortality, reoperation, urinary tract infection, deep vein thrombosis, pneumonia, superficial surgical site infection, and organ space infection were the primary outcomes measured.
  
  
  METHODS
  We compared annual and 5-year institutional and surgeon-specific adverse event rates between the data sets. In addition, we categorized individual surgeons as low-outlier, average, or high-outlier in relation to aggregate averages and determined the concordance between the data sets in identifying outliers. Concordance was designated if the 2 databases classified outlier status similarly for the same adverse event category.
  
  
  RESULTS
  In the 100% capture institutional data, 6459 operative encounters were identified in comparison with 1786 National Surgical Quality Improvement Program encounters (28% sampled). Annual aggregate adverse event rates were similar between the institutional data and the National Surgical Quality Improvement Program. For annual surgeon-specific comparisons, concordance in identifying outliers between the 2 data sets was 51.4%, and gross discordance between outlier status was in 8.2%. Five-year surgeon-specific comparisons demonstrated 59% concordance in identifying outlier status with 8.2% gross discordance for the group.
  
  
  CONCLUSIONS
  The inclusion of data from only 1 academic referral center is a limitation of this study.
  
  
  CONCLUSIONS
  Each surgeon was identified as a "high outlier" in at least 1 adverse event category. Comparisons at the annual and 5-year points demonstrated poor concordance between our 100% capture institutional data and the National Surgical Quality Improvement Program data.
authors.affiliation: Department of Colorectal Surgery, Lahey Clinic, Burlington, Massachusetts.
authors.forename: Angela H
authors.initials: AH
authors.lastname: Kuhnen
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Rusin
authors.forename: Jason F
authors.initials: JF
authors.lastname: Hall
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D015331:Cohort Studies; D003107:Colorectal Surgery / Q000592:standards*; D006801:Humans; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data; D066231:Surgeons / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology