title: Current Quality Measurement Tools Are Insufficient to Assess Complications in Orthopedic Surgery.
abstract: OBJECTIVE
  The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) is a clinically-derived, validated tool to track outcomes in surgery. The Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) are a set of computer algorithms run on administrative data to identify adverse events. The purpose of this study is to compare complications following orthopedic surgery identified by ACS-NSQIP and AHRQ-PSI.
  
  
  METHODS
  Patients between 2010 and 2012 who underwent orthopedic procedures (arthroplasty, spine, trauma, foot and ankle, hand, and upper extremity) at our tertiary-care, academic institution were identified (n = 3,374). Identification of inpatient adverse events by AHRQ-PSI in the cohort was compared with 30-day events identified by ACS-NSQIP. Adverse events common to both AHRQ-PSI and ACS-NSQIP were infection, sepsis, venous thromboembolism, bleeding, respiratory failure, wound disruption, and renal failure. Concordance between AHRQ-PSI and ACS-NSQIP for identifying adverse events was examined.
  
  
  RESULTS
  A total of 729 adverse events (21.6%) were identified in the cohort using ACS-NSQIP methodology and 35 adverse events (1.0%) were found using AHRQ-PSI. Only 12 events were identified by both methodologies. The most common complication was bleeding in ACS-NSQIP (18.1%) and respiratory failure in AHRQ-PSI (0.53%). The overlap was highest for venous thromboembolic events. There was no overlap in adverse events for 5 of the 7 categories of adverse events.
  
  
  CONCLUSIONS
  A large discrepancy was observed between adverse events reported in ACS-NSQIP and AHRQ-PSI. A large percentage of clinically important adverse events identified in ACS-NSQIP were missed in AHRQ-PSI algorithms. The ability of AHRQ-PSI for detecting adverse events varied widely with ACS-NSQIP.
  
  
  CONCLUSIONS
  AHRQ-PSI algorithms currently are insufficient to assess the quality of orthopedic surgery.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Arjun S
authors.initials: AS
authors.lastname: Sebastian
authors.affiliation: Department of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.affiliation: Department of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Glasgow
authors.affiliation: Department of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. Electronic address: kakar.sanjeev@mayo.edu.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kakar
mesh_terms: D006801:Humans; D019637:Orthopedic Procedures / Q000592:standards*; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D014481:United States / Q000453:epidemiology
keywords: Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI); American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP); Quality