American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes


Many hospitals have trouble tracking surgical complications and may lack the data necessary to analyze and take appropriate steps to fix problem areas. You can’t improve a hospital’s surgical quality if you can’t measure it; and for that you need robust, valid data. Yet 59 percent of surveyed sites were unaware of their hospital’s surgical complication rate before they joined the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®).1

ACS NSQIP data enhances a hospital’s ability to zero in on preventable complications. Because it was developed by surgeons who understand the realities of the operating room, ACS NSQIP helps hundreds of hospitals across the country gauge the quality of their surgical programs with unrivaled precision and measurably improve surgical outcomes.

What makes ACS NSQIP different from other quality programs?

ACS NSQIP collects data that provides fair, in-depth and insightful analysis, helping surgeons and hospitals better understand their quality of care compared to similar hospitals with similar patients.

ACS NSQIP uses data that are:

  • From the patient’s medical chart, not insurance claims:Most quality programs use easily obtainable claims or billing data. But claims data are limited, inconsistent and subject to interpretation when used to measure quality. In a study comparing ACS NSQIP data to administrative and claims data collected by the University Health System Consortium (UHC) program,2 ACS NSQIP identified 61 percent more complications than UHC, including 97 percent more surgical site infections.
  • Risk-adjusted:ACS NSQIP lets you compare apples to apples. Your data is risk-adjusted, based on models in use for more than 20 years. Caring for a chronically ill 75-year-old is very different from treating a healthy 21-year-old, and quality measures should take these differences into account.
  • Case-mix-adjusted:ACS NSQIP allows a hospital that takes on more complex surgical cases to meaningfully calibrate its results against one that performs more straightforward procedures. ACS NSQIP accounts for the complexity of operations performed, allowing for more accurate national benchmarking. 
  • Based on 30-day patient outcomes:Studies show half or more of all complications occur after the patient leaves the hospital, often leading to costly readmissions. ACS NSQIP tracks patients for 30 days after their operation, providing a more complete picture of their care. For example, in the case of colectomies, one of the most common procedures performed in hospitals, one-half of cardiac arrests and two-thirds of infections occur after the patient leaves the hospital.3 Our concern for the patient doesn’t stop at the hospital door, and our efforts to measure and track their care shouldn’t either.

Complications Missed by Administrative DataHow It Works

Each hospital assigns a trained Surgical Clinical Reviewer (SCR) to collect preoperative through 30-day postoperative data on randomly assigned patients. The number and types of variables collected will differ from hospital to hospital, depending on the hospital’s size, patient population and quality improvement focus. The ACS provides SCR training, ongoing education opportunities and auditing to ensure data reliability. Data are entered online in a HIPAA-compliant, secure, web-based platform that can be accessed 24 hours a day. A surgeon champion assigned by each hospital leads and oversees program implementation and quality initiatives. Blinded, risk-adjusted information is shared with all hospitals, allowing them to nationally benchmark their complication rates and surgical outcomes. ACS also provides monthly conference calls, best practice guidelines and many other resources to help hospitals target problem areas and improve surgical outcomes.

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1 Ko C. “ACS NSQIP Conference and Semiannual Report Overview.” Presentation at the 2009 ACS NSQIP National Conference. July 2009.
2 Steinberg S, Popa M, et al. “Comparison of risk-adjustment methodologies in surgical quality improvement.” Surgery. 144(4):662-7; discussion 662-7; Oct. 2008.
3 Wick, Elizabeth C., et al. “Readmission Rates and Cost Following Colorectal Surgery.” Diseases of the Colon & Rectum. 54(12):1475-1479; Dec. 2011.