Presented at the 9th Annual Meeting of the American Hepato-Pancreato-Biliary Association, 12–15 March 2009, Miami, FL, USA.
ACS-NSQIP has the potential to create an HPB-NSQIP option
Article first published online: 22 JUL 2009
© 2009 International Hepato-Pancreato-Biliary Association
Volume 11, Issue 5, pages 405–413, August 2009
How to Cite
Pitt, H. A., Kilbane, M., Strasberg, S. M., Pawlik, T. M., Dixon, E., Zyromski, N. J., Aloia, T. A., Henderson, J. M. and Mulvihill, S. J. (2009), ACS-NSQIP has the potential to create an HPB-NSQIP option. HPB, 11: 405–413. doi: 10.1111/j.1477-2574.2009.00074.x
- Issue published online: 22 JUL 2009
- Article first published online: 22 JUL 2009
- Received 20 March 2009; accepted 4 May 2009
Background: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was started in 2004. Presently, 58% of the 198 hospitals participating in ACS-NSQIP are academic or teaching hospitals. In 2008, ACS-NSQIP initiated a number of changes and made risk-adjusted data available for use by participating hospitals. This analysis explores the ACS-NSQIP database for utility in developing hepato-pancreato-biliary (HPB) surgery-specific outcomes (HPB-NSQIP).
Methods: The ACS-NSQIP Participant Use File was queried for patient demographics and outcomes for 49 HPB operations from 1 January 2005 through 31 December 2007. The procedures included six hepatic, 16 pancreatic and 23 complex biliary operations. Four laparoscopic or open cholecystectomy operations were also studied. Risk-adjusted probabilities for morbidity and mortality were compared with observed rates for each operation.
Results: During this 36-month period, data were accumulated on 9723 patients who underwent major HPB surgery, as well as on 44 189 who received cholecystectomies. The major HPB operations included 2847 hepatic (29%), 5074 pancreatic (52%) and 1802 complex biliary (19%) procedures. Patients undergoing hepatic resections were more likely to have metastatic disease (42%) and recent chemotherapy (7%), whereas those undergoing complex biliary procedures were more likely to have significant weight loss (20%), diabetes (13%) and ascites (5%). Morbidity was high for hepatic, pancreatic and complex biliary operations (20.1%, 32.4% and 21.2%, respectively), whereas mortality was low (2.3%, 2.7% and 2.7%, respectively). Compared with laparoscopic cholecystectomy, the open operation was associated with higher rates of morbidity (19.2% vs. 6.0%) and mortality (2.5% vs. 0.3%). The ratios between observed and expected morbidity and mortality rates were <1.0 for hepatic, pancreatic and biliary operations.
Conclusions: These data suggest that HPB operations performed at ACS-NSQIP hospitals have acceptable outcomes. However, the creation of an HPB-NSQIP has the potential to improve quality, provide risk-adjusted registries with HPB-specific data and facilitate multi-institutional clinical trials.