First Report of a Multiphase Pilot to Measure Patient-Reported Outcomes in the American College of Surgeons National Surgical Quality Improvement Program.

BACKGROUND: Incorporating the patient's perspective to evaluate national surgical quality has yet to be achieved in the United States and represents a tremendous unrealized opportunity for continuous quality improvement. The first phase of a multiphase pilot to measure patient-reported outcomes (PROs) using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is described. METHODS: After conducting a baseline knowledge assessment and stakeholder engagement activities, a pilot to capture PROs was implemented using the ACS NSQIP platform. Hospital participation was voluntary. A 45-item survey was compiled from three validated PRO measures and administered electronically to patients accrued into the ACS NSQIP registry. Constructs measured were overall health-related quality of life, pain interference, and experiences of care. Lessons learned during implementation were compiled, and preliminary data analyses were conducted. RESULTS: Between October 2017 and March 2018, 1,324 patients from 17 hospitals in the United States and Canada responded to the survey. Responding patients underwent 348 different types of operations, varying in complexity and riskiness. The median age of respondents was 63 years (interquartile range: 52-70), and the survey took on average 6.4 minutes to complete. Hospital response rates ranged from 10% to 50% with a 20% median. CONCLUSION: The implementation of this first phase demonstrates that the measurement of PROs is possible using the ACS NSQIP and that the barriers-perceived or real-can be reasonably overcome.

Have Recent Modifications of Operating Room Attire Policies Decreased Surgical Site Infections? An American College of Surgeons NSQIP Review of 6,517 Patients.

BACKGROUND: After a Department of Health site visit, 2 teaching hospitals imposed strict regulations on operating room attire, including full coverage of ears and facial hair. We hypothesized that this intervention would reduce superficial surgical site infections (SSIs). STUDY DESIGN: We compared NSQIP data from all patients undergoing operations in the 9 months before implementation (n = 3,077) to time-matched data 9 months post-implementation (n = 3,440). Univariate and multivariable analyses were used to examine patient, clinical, and operative factors associated with SSIs. Power analysis was performed using pre-intervention SSI rates. RESULTS: Despite a shift toward more clean cases, there were more SSIs post-implementation (33 vs 30 [1%]; p = 0.95). There were no differences in length of stay, complications, or mortality between the 2 time periods. Overall, SSI increased with wound class: 0.6%, 0.9%, 2.3%, and 3.8% in clean, clean-contaminated, contaminated, and infected cases, respectively. Limiting the review to clean or clean-contaminated cases, incisional SSIs increased from 0.7% (20 of 2,754) to 0.8% (24 of 3,115) (p = 0.85). A multivariable analysis showed that implementation of these policies was not associated with decreased SSIs (odds ratio 1.2; 95% CI 0.70 to 1.96; p = 0.56). The largest predictors of SSIs were preoperative infection, operative time >75th percentile, open wounds, and dirty/contaminated wounds. A hypothetical analysis revealed that a sample size of 485,154 patients would be required to demonstrate a 10% SSI reduction among patients with clean or clean-contaminated wounds. CONCLUSIONS: Implementation of stringent operating room attire policies do not reduce SSI rates. A study to prove this principle further would be impractical to conduct.