AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM. SAR Models. Vanessa Thompson, PhD
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1 AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM SAR Models Vanessa Thompson, PhD ACS NSQIP National Conference General Session: Stats I July 26, 2015
2 No disclosures
3 Overview SAR models & outcomes Case inclusion/filters Event filters Additional resources
4 Adult: SAR Model Growth # of Models Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 Jan-10 Jul-10 Jan-11 Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Semi-Annual Report
5 Adult: SAR Model Growth Essential Measures (Parsimonious) Procedure Targeted # of Models Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 Jan-10 Jul-10 Jan-11 Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Semi-Annual Report
6 Adult: Essential Models All Cases General/Vascular General Vascular Colorectal Measures Subspecialty Cardiac Gynecology Neurosurgery Orthopedics Otolaryngology Plastics Thoracic Urology Emergency General Colon
7 Adult: Essential Models Length of Stay (75 th Percentile) Length of Stay GEN Pancreatectomy Colectomy Proctectomy Hepatectomy Esophagectomy NSG Brain Tumor URO Nephrectomy Cystectomy THOR Lung Resection VASC AAA, EVAR, AIO, LEO Procedure Targeted CPT Classifications
8 Adult: Essential Outcomes Models All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay Outcomes Mortality Morbidity Cardiac Pneumonia Unplanned Intubation Ventilator > 48 Hrs VTE Renal Failure UTI SSI Sepsis Return to OR Readmission
9 Adult: Essential Outcomes Models All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay Outcomes Mortality Morbidity Length of Stay (75th Percentile) Pneumonia Unplanned Intubation Ventilator > 48 Hrs VTE Renal Failure UTI SSI Sepsis Return to OR Readmission
10 Adult: Essential Outcomes Models All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay Outcomes Mortality Morbidity Cardiac Pneumonia Unplanned Intubation Ventilator > 48 Hrs VTE Renal Failure UTI SSI Sepsis Return to OR Readmission
11 Adult: Essential Outcomes Models All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay Outcomes Death or Serious Morbidity Elderly Death or Serious Morbidity Colon Death or Serious Morbidity Colon SSI Deep Incision / Organ Space SSI UTI Lower Extremity Bypass Death or Serious Morbidity
12 Adult: Essential Outcomes Models All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay Outcomes GEN Mortality GEN Morbidity COLON Morbidity
13 Adult: Essential Outcomes Models Outcomes All Cases General/Vascular General Vascular Colorectal Subspecialty Measures Emergency Length of Stay GEN Pancreatectomy LOS GEN Colectomy LOS GEN Proctectomy LOS GEN Hepatectomy LOS GEN Esophagectomy LOS NSG Brain Tumor LOS URO Nephrectomy LOS URO Cystectomy LOS THOR Lung Resection LOS VASC AAA LOS VASC EVAR LOS VASC AIO LOS VASC LEO LOS LOS (75 th Percentile)
14 Adult: Targeted Models General Distal/Whipple Pancreatectomy Colectomy Ventral Hernia Repair Bariatric Hepatectomy Thyroidectomy Esophagectomy Appendectomy Gynecology Hysterectomy or Myomectomy Reconstruction Neurosurgery Spine Brain Tumor Urology TURP Bladder suspension Prostatectomy Nephrectomy Cystectomy Orthopedics TKA THA Hip Fracture Plastics Flap Breast Reduction Breast Reconstruction Abdominoplasty Thoracic Lung Resection Vascular CEA, CAS AAA, EVAR AIO, AIE LEO, LEE
15 Adult: Targeted Outcomes Models General (subset) Ventral Hernia Repair Bariatric Thyroidectomy Esophagectomy Appendectomy Gynecology Neurosurgery Urology Orthopedics Plastics Thoracic Vascular Outcomes Mortality Morbidity Cardiac Pneumonia Unplanned Intubation Ventilator > 48 Hrs VTE Renal Failure UTI SSI Sepsis Return to OR Readmission
16 Adult: Targeted Outcomes Models General (subset) Distal/Whipple Pancreatectomy Colectomy Hepatectomy Gynecology Hysterectomy or Myomectomy Reconstruction Vascular CEA, CAS AAA, EVAR AIO, AIE LEO, LEE Outcomes 13 Standard NSQIP Outcomes Procedure-Specific Outcomes January 2013 Vascular July 2014 Colectomy July 2015 Pancreatectomy, Hepatectomy, & Gynecology
17 Pediatric: SAR Model Growth # of Models Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Semi-Annual Report
18 Pediatric: Models All Surgeries / All Patients Abdominal Neonate Pediatric Subspecialty General Orthopedic Otolaryngology Thoracic Plastics Urology Neurosurgery Spine Orthopedic/Hand
19 Pediatric: Outcomes Models All Surgeries, All Patients Abdominal Subspecialty Outcomes Mortality Morbidity SSI VT Reintubation Cardiac Pneumonia Renal Failure UTI
20 Pediatric: Outcomes Models All Surgeries, All Patients Abdominal Subspecialty Outcomes Mortality Morbidity SSI VT Reintubation Cardiac Pneumonia Renal Failure UTI
21 What cases are included in the Adult/Pediatric models? What kinds of filters are applied?
22 Case Inclusion/Filters: Adult Participation Options Essential Small & Rural Measures Procedure Targeted All Cases General/Vascular General Vascular Colorectal Emergency Subspecialty Length of Stay Measures Models General Gynecology Neurology Urology Orthopedics Plastics Thoracic Vascular
23 Case Inclusion/Filters: Adult Essentials CPT Inclusion List Automatic Assignment All Cases General/Vascular General Vascular Colorectal Measures Subspecialty Emergency *Length of Stay* Overlapping Specialties: Acceptable Surgeon Specialty (Neuro, Ortho, Plastics) Procedure Targeted CPT Inclusion List Procedure Targeted Hospitals Various Specialties: Surgeon Specialty
24 Case Inclusion/Filters: Pediatric Full CPT Inclusion List All Surgeries / All Patients Abdominal: Neonate Abdominal: Pediatric Subspecialty: Automatic Assignment Overlapping Specialties: Acceptable Surgeon Specialty (Neuro, Ortho, Plastics, ENT) Various Specialties: Surgeon Specialty Procedure Targeted CPT Inclusion List (Anticipated July 2016)
25 Note of Caution Workstation filtered cases may be different than SAR filtered cases because of the CPT Surgical Specialty Algorithm SAR Case Occurrences Report
26 Event Filters: Adult PATOS Pneumonia Ventilator > 48 Hrs Unplanned Intubation Renal Failure UTI SSI Sepsis Non-Event Pre-Existing Pre-Op Condition Post-Op Event Event
27 Event Filters: Pediatric Pre-Existing Conditions Outcomes Pneumonia Pneumonia Ventilator Dependence Reintubation Renal Failure / Dialysis Renal Insufficiency Renal Failure
28 Additional Resources Main SAR documents SAR Case Occurrences Report Monday General Sessions Adult Statistical Reporting 8-9:30am Pediatric Statistical Reporting 8-9:30am Program Documents Participation options Operations Manual Variable definitions
29 Statistical Team Mark Cohen, PhD Lynn Zhou, PhD Kristopher Huffman, MS Yaoming Liu, PhD Xiangju Meng, MS Shenglin Chen, PhD Kari Kraemer, PhD Vanessa Thompson, PhD Brian Matel
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