Current Quality Measurement Tools Are Insufficient to Assess Complications in Orthopedic Surgery

Arjun S. Sebastian, Stephanie F. Polites, Amy E. Glasgow, Elizabeth B. Habermann, Robert R. Cima, Sanjeev Kakar

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Purpose The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) is a clinically-derived, validated tool to track outcomes in surgery. The Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) are a set of computer algorithms run on administrative data to identify adverse events. The purpose of this study is to compare complications following orthopedic surgery identified by ACS-NSQIP and AHRQ-PSI. Methods Patients between 2010 and 2012 who underwent orthopedic procedures (arthroplasty, spine, trauma, foot and ankle, hand, and upper extremity) at our tertiary-care, academic institution were identified (n = 3,374). Identification of inpatient adverse events by AHRQ-PSI in the cohort was compared with 30-day events identified by ACS-NSQIP. Adverse events common to both AHRQ-PSI and ACS-NSQIP were infection, sepsis, venous thromboembolism, bleeding, respiratory failure, wound disruption, and renal failure. Concordance between AHRQ-PSI and ACS-NSQIP for identifying adverse events was examined. Results A total of 729 adverse events (21.6%) were identified in the cohort using ACS-NSQIP methodology and 35 adverse events (1.0%) were found using AHRQ-PSI. Only 12 events were identified by both methodologies. The most common complication was bleeding in ACS-NSQIP (18.1%) and respiratory failure in AHRQ-PSI (0.53%). The overlap was highest for venous thromboembolic events. There was no overlap in adverse events for 5 of the 7 categories of adverse events. Conclusions A large discrepancy was observed between adverse events reported in ACS-NSQIP and AHRQ-PSI. A large percentage of clinically important adverse events identified in ACS-NSQIP were missed in AHRQ-PSI algorithms. The ability of AHRQ-PSI for detecting adverse events varied widely with ACS-NSQIP. Clinical relevance AHRQ-PSI algorithms currently are insufficient to assess the quality of orthopedic surgery.

Original languageEnglish (US)
Pages (from-to)10-15.e1
JournalJournal of Hand Surgery
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI)
  • American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)
  • Quality

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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