title: What Is the Best Way to Measure Surgical Quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus Traditional Morbidity and Mortality Conferences.
abstract: BACKGROUND
  Morbidity and mortality conferences have played a traditional role in tracking complications. Recently, the American College of Surgeons National Surgical Quality Improvement Program Pediatrics (ACS NSQIP-P) has gained popularity as a risk-adjusted means of addressing quality assurance. The purpose of this article is to report an analysis of the two methodologies used within pediatric plastic surgery to determine the best way to manage quality.
  
  
  METHODS
  ACS NSQIP-P and morbidity and mortality data were extracted for 2012 and 2013 at a quaternary care institution. Overall complication rates were compared statistically, segregated by type and severity, followed by a subset comparison of ACS NSQIP-P-eligible cases only. Concordance and discordance rates between the two methodologies were determined.
  
  
  RESULTS
  One thousand two hundred sixty-one operations were performed in the study period. Only 51.4 percent of cases were ACS NSQIP-P eligible. The overall complication rates of ACS NSQIP-P (6.62 percent) and morbidity and mortality conferences (6.11 percent) were similar (p = 0.662). Comparing for only ACS NSQIP-P-eligible cases also yielded a similar rate (6.62 percent versus 5.71 percent; p = 0.503). Although different complications are tracked, the concordance rate for morbidity and mortality and ACS NSQIP-P was 35.1 percent and 32.5 percent, respectively.
  
  
  CONCLUSIONS
  The ACS NSQIP-P database is able to accurately track complication rates similarly to morbidity and mortality conferences, although it samples only half of all procedures. Although both systems offer value, limitations exist, such as differences in definitions and purpose. Because of the rigor of the ACS NSQIP-P, we recommend that it be expanded to include currently excluded cases and an extension of the study interval.
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Jacques X
authors.initials: JX
authors.lastname: Zhang
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Diana
authors.initials: D
authors.lastname: Song
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Julie
authors.initials: J
authors.lastname: Bedford
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Bucevska
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Courtemanche
authors.affiliation: Vancouver, British Columbia, Canada.|From the Faculty of Medicine and the Division of Plastic Surgery, British Columbia Children's Hospital, University of British Columbia.
authors.forename: Jugpal S
authors.initials: JS
authors.lastname: Arneja
mesh_terms: D002170:Canada; D016208:Databases, Factual; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D019651:Plastic Surgery Procedures / Q000401:mortality*; D014481:United States