Original Communication| Volume 155, ISSUE 4, P593-601, April 2014

Quality improvement in gastrointestinal surgical oncology with American College of Surgeons National Surgical Quality Improvement Program

Published:December 16, 2013DOI:


      To assess the impact of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participation on outcomes in gastrointestinal surgical oncology.

      Study design

      A total of 6,076 resections for esophageal, gastric, pancreatic, hepatobiliary, and colorectal cancers at 316 hospitals from the 2006 to 2011 ACS NSQIP were examined. Thirty-day complication rates were analyzed longitudinally over time with the use of multiple regression; we adjusted for operation type and preoperative risk factors.


      The procedure mix was 3% esophagectomy, 5% gastrectomy, 16% pancreatectomy, 4% hepatectomy, 63% colectomy, and 9% proctectomy. Median age was 66 years, and 52% were male, 41% were American Society of Anesthesiologists class 2, and 52% were American Society of Anesthesiologists 3. Depending on anatomic surgical site, 21–45% of patients experienced a postoperative complication and 1.1–4.4% died. The incidence of patients with any complication decreased from 28 to 24% over the period (risk-adjusted odds ratio 0.95 per year, 95% confidence interval 0.94–0.96). In contrast, there was no substantial change in risk-adjusted mortality over the period (odds ratio 1.03, 95% confidence interval 0.99–1.07).


      There was a decrease in complications over time for ACS NSQIP participants in gastrointestinal surgical oncology, but mortality did not decrease.
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        • Bilimoria K.Y.
        • Phillips J.D.
        • Rock C.E.
        • Hayman A.
        • Prystowsky J.B.
        • Bentrem D.J.
        Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature.
        Ann Surg Oncol. 2009; 16: 1799-1808
        • Hillner B.E.
        • Smith T.J.
        • Desch C.E.
        Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care.
        J Clin Oncol. 2000; 18: 2327-2340
        • Bilimoria K.Y.
        • Bentrem D.J.
        • Feinglass J.M.
        • et al.
        Directing surgical quality improvement initiatives: comparison of perioperative mortality and long-term survival for cancer surgery.
        J Clin Oncol. 2008; 26: 4626-4633
        • Begg C.B.
        • Cramer L.D.
        • Hoskins W.J.
        • Brennan M.F.
        Impact of hospital volume on operative mortality for major cancer surgery.
        JAMA. 1998; 280: 1747-1751
        • Learn P.A.
        • Bach P.B.
        A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement.
        Med Care. 2010; 48: 1041-1049
        • Ingraham A.M.
        • Richards K.E.
        • Hall B.L.
        • Ko C.Y.
        Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach.
        Adv Surg. 2010; 44: 251-267
        • Khuri S.F.
        The NSQIP: a new frontier in surgery.
        Surgery. 2005; 138: 837-843
        • Khuri S.F.
        • Henderson W.G.
        • Daley J.
        • et al.
        Successful implementation of the Department of Veterans Affairs' National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study.
        Ann Surg. 2008; 248: 329-336
        • Hall B.L.
        • Hamilton B.H.
        • Richards K.
        • Bilimoria K.Y.
        • Cohen M.E.
        • Ko C.Y.
        Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals.
        Ann Surg. 2009; 250: 363-376
        • Guillamondegui O.D.
        • Gunter O.L.
        • Hines L.
        • et al.
        Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to improve surgical outcomes.
        J Am Coll Surg. 2012; 214: 709-714
        • Henderson W.G.
        • Daley J.
        Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is?.
        Am J Surg. 2009; 198: S19-S27
      1. ACS NSQIP Data Collection, Analysis, and Reporting. Available from:

      2. ACS NSQIP History.

        • Ohtani H.
        • Tamamori Y.
        • Arimoto Y.
        • et al.
        A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer.
        J Cancer. 2012; : 349-357
        • Ozhathil D.K.
        • Li Y.
        • Smith J.K.
        • et al.
        Colectomy performance improvement within NSQIP 2005-2008.
        J Surg Res. 2011; 171: e9-13
      3. ACS NSQIP Program Options. Available from: