Harnessing ACS NSQIP Statewide Collaboratives for QI and Research: Tennessee Surgical Quality Collaborative (TSQC)
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1 Harnessing ACS NSQIP Statewide Collaboratives for QI and Research: Tennessee Surgical Quality Collaborative (TSQC) Tennessee Chapter
2 Brian J Daley, MD, MBA, FACS, William Cecil, MBA, P Chris Clarke, RN, Joseph B Cofer, MD, FACS, Oscar D Guillamondegui, MD, FACS. How Slow Is Too Slow? Correlation of Operative Time to Complications: An Analysis from the Tennessee Surgical Quality Collaborative. J Am Coll Surg2015 Apr; 220(4): doi: /j.jamcollsurg Epub 2015 Jan 9..
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4 Can Raw Operative Time Alone Predict Postoperative Occurrences? Area Under the Curve Area Operative Time.73 Risk Model.76 Risk-Adjustment for Comparing Hospital Quality with Surgery: How Many Variables Are Needed? Justin B Dimick, MD, MPH, FACS, Nicholas H Osborne, MD, MS, Bruce L Hall, MD, PhD, FACS*, Clifford Y Ko, MD, MS, FACS+, and John D Birkmeyer, MD, FACS Michigan Surgical Collaborative for Outcomes Research and Evaluation (M-SCORE), Department of Surgery, University of Michigan, Ann Arbor, MI C-indices for all 5 procedures combined of 0.93 vs for mortality and 0.78 vs for morbidity J Am Coll Surg April ; 210(4): doi: /j.jamcollsurg
5 Raw Operative Time Can Not Predict Mortality Area Under the Curve Test Result Variable(s) Area Predicted MORTALITY.931 Observed Operative Time.569
6 Hospital SITE Example Report for Operative Time SITE A Operative Time (Hrs) Operative Time per Case (Hrs) Risk-Adjusted Reliability Reliability Procedure Group case Observed Adjusted Expected Observed Adjusted Expected RR LCL UCL Cholecystectomy Joint Repair / Replacement Vascular bypass Procedure groups highlighted in blue represent operative times that are significantly less than expected Procedure groups highlighted in red represent operative times that are significantly greater than expected
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9 Surgeon Specific Reporting Processing Results by Step Measure Processing Step Number of Surgeons Number of Cases Surgeons (%) Cases (%) Total Postoperative Occurrences All , Risk Adjustment , Reliability , Reliability , Scored , Operative Time All ,392* Risk Adjustment , Reliability , Reliability , Scored , * Cases with a single procedure only are included for operative time reporting
10 Surgeon Specific Example Report for Postoperative Occurrences and Operative Time Risk-Adjusted Total Postoperative Occurrences Postoperative Occurrences/Case SITESURGEONID Cases Observed Rel Adj Expected Observed Rel Adj Expected Reliability RR LCL UCL A A A Surgeon ID's highlighted in blue represent either operative time or postoperative occurrences that are significantly less than expected Surgeon ID's highlighted in red represent either operative time or postoperative occurrences that are significantly greater than expected Risk-Adjusted Total Operative Time (HRS) Operative Time/Case (HRS) SITESURGEONID case Observed Rel Adj Expected Observed Rel Adj Expected Reliability RR LCL UCL A A A
11 Summary Both operative time and surgeon specific reporting have been pursued as research goals to provide improved information to assist TSQC nurses, surgeons and hospitals in quality improvement. It is not our intention for research to be limited to quality improvement only.
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