title: Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery.
  
  
  METHODS
  A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI).
  
  
  RESULTS
  Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program.
  
  
  CONCLUSIONS
  These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Montroy
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Sonya
authors.initials: S
authors.lastname: Cnossen
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Witiuk
authors.affiliation: School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Binette
authors.affiliation: School of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Taylor
authors.initials: T
authors.lastname: Ferrier
authors.affiliation: Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Luke T
authors.initials: LT
authors.lastname: Lavallée
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Schramm
mesh_terms: D016208:Databases, Factual; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications; D015397:Program Evaluation; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality
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