ABSTRACT
The largest and best-known intervention for reporting surgical outcomes in the United States is the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). This program provides risk-adjusted postoperative outcomes as benchmarks intended to spur local quality improvement efforts. In response to concerns about high complication rates, VA NSQIP was launched in 1994 to collect and report clinical variables and outcomes across all Veterans Affairs (VA) hospitals. A 2015 study examining outcome trends among hospitals participating in ACS NSQIP for at least 3 years found that 69", 79", and 71" had improved their mortality, morbidity, and surgical site infection rates, respectively. The cost to participating hospitals includes an annual administrative fee to support the statistical methods and the generation of reports, a salary for the surgical clinical reviewer, and sometimes bonus payments to support the surgeon champion or quality improvement teams. Few studies assessed the potential and actual harm of this program.
