title: A National Database Analysis Comparing the Nationwide Inpatient Sample and American College of Surgeons National Surgical Quality Improvement Program in Laparoscopic vs Open Colectomies: Inherent Variance May Impact Outcomes.
abstract: BACKGROUND
  Clinical and administrative databases each have fundamental distinctions and inherent limitations that may impact results.
  
  
  OBJECTIVE
  This study aimed to compare the American College of Surgeons National Surgical Quality Improvement Program and the Nationwide Inpatient Sample, focusing on the similarities, differences, and limitations of both data sets.
  
  
  METHODS
  All elective open and laparoscopic segmental colectomies from American College of Surgeons National Surgical Quality Improvement Program (2006-2013) and Nationwide Inpatient Sample (2006-2012) were reviewed. International Classification of Diseases, Ninth Revision, Clinical Modification coding identified Nationwide Inpatient Sample cases, and Current Procedural Terminology coding for American College of Surgeons National Surgical Quality Improvement Program. Common demographics and comorbidities were identified, and in-hospital outcomes were evaluated.
  
  
  METHODS
  A national sample was extracted from population databases.
  
  
  METHODS
  Data were derived from the Nationwide Inpatient Sample database: 188,326 cases (laparoscopic = 67,245; open = 121,081); and American College of Surgeons National Surgical Quality Improvement Program: 110,666 cases (laparoscopic = 54,191; open = 56,475).
  
  
  METHODS
  Colectomy data were used as an avenue to compare differences in patient characteristics and outcomes between these 2 data sets.
  
  
  RESULTS
  Laparoscopic colectomy demonstrated superior outcomes compared with open; therefore, results focused on comparing a minimally invasive approach among the data sets. Because of sample size, many variables were statistically different without clinical relevance. Coding discrepancies were demonstrated in the rate of conversion from laparoscopic to open identified in the National Surgical Quality Improvement Program (3%) and Nationwide Inpatient Sample (15%) data sets. The prevalence of nonmorbid obesity and anemia from National Surgical Quality Improvement Program was more than twice that of Nationwide Inpatient Sample. Sepsis was statistically greater in National Surgical Quality Improvement Program, with urinary tract infections and acute kidney injury having a greater frequency in the Nationwide Inpatient Sample cohort. Surgical site infections were higher in National Surgical Quality Improvement Program (30-day) vs Nationwide Inpatient Sample (8.4% vs 2.6%; p < 0.01), albeit less when restricted to infections that occurred before discharge (3.3% vs 2.6%; p < 0.01).
  
  
  CONCLUSIONS
  This is a retrospective study using population-based data.
  
  
  CONCLUSIONS
  This analysis of 2 large national databases regarding colectomy outcomes highlights the incidence of previously unrecognized data variability. These discrepancies can impact study results and subsequent conclusions/recommendations. These findings underscore the importance of carefully choosing and understanding the different population-based data sets before designing and when interpreting outcomes research.
authors: 1 Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 2 Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 3 Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii 4 Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Andrew T
authors: AT
authors: Schlussel
authors: Conor P
authors: CP
authors: Delaney
authors: Justin A
authors: JA
authors: Maykel
authors: Michael B
authors: MB
authors: Lustik
authors: Madhuri
authors: M
authors: Nishtala
authors: Scott R
authors: SR
authors: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D000068598:Data Accuracy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult