Background
Surgical clinical registries provide clinical information with the intent of measuring
and improving quality. This study aimed to describe how surgical clinical registries
have been used to measure surgical quality, the reported findings, and the limitations
of registry measurements.
Methods
Medline, CINAHL, and Cochrane were queried for English articles with the terms: “registry
AND surgery AND quality.” Eligibility criteria were studies explicitly assessing quality
measurement with registries as the primary data source. Studies were abstracted to
identify registries, define registry structure, uses for quality measurement, and
limitations of the measurements used.
Results
A total of 111 studies of 18 registries were identified for data abstraction. Two
registries were financed privately, and 5 registries were financed by a governmental
organization. Across registries, the most common uses of process measures were for
monitoring providers and as platforms for quality improvement initiatives. The most
common uses of outcome measures were to improve quality modeling and to identify preoperative
risk factors for poor outcomes. Eight studies noted improvements in risk-adjusted
mortality with registry participation; one found no change. A major limitation is
bias from context and means of data collection threatening internal validity of registry
quality measurement. Conversely, the other major limitation is the cost of participation,
which threatens the external validity of registry quality measurement.
Conclusion
Clinical registries have advanced surgical quality definition, measurement, and modeling
as well as having served as platforms for local initiatives for quality improvement.
The implication of this finding is that subsidizing registry participation may improve
data validity as well as engage providers in quality improvement.
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References
- Clinical versus administrative data bases for CABG surgery. Does it matter?.Med Care. 1992; 30: 892-907
- Accuracy of administrative data in trauma: splenic injuries as an example.J Trauma. 2000; 49: 679-686
- Ultrasound-guided femoral vein catheterization in neonates with cardiac disease*.Pediatr Crit Care Med. 2012; 13: 654-659
- Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program.J Am Coll Surg. 2002; 194: 257-266
- Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards.Circulation. 2007; 115: 1518-1527
- A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications.Ann Surg. 2012; 256: 973-981
- Can administrative data be used to compare postoperative complication rates across hospitals?.Med Care. 2002; 40: 856-867
- The impact of the cancer control programs of the American College of Surgeons.Prog Clin Biol Res. 1981; 57: 21-29
- The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program.Ann Surg. 1998; 228: 491-507
- Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery.Ann Thorac Surg. 1990; 50 (discussion 27-8): 12-26
- A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. The Northern New England Cardiovascular Disease Study Group.J Am Med Assoc. 1991; 266: 803-809
- A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases.Ann Surg. 2001; 234 (discussion 472-4): 464-472
- Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors.Med Care. 1991; 29: 1094-1107
- Transplant data: sources, collection and research considerations, 2004.Am J Transplant. 2005; 5: 850-861
- Analytical methods and database design: implications for transplant researchers, 2005.Am J Transplant. 2006; 6: 1228-1242
- Analyses of the UNOS Scientific Renal Transplant Registry at three years–early events affecting transplant success.Transplantation. 1992; 53: 59-64
- Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.N Engl J Med. 1992; 327: 834-839
- American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry.J Trauma. 1994; 37 (discussion 573-5): 565-573
- Surveillance bias and deep vein thrombosis in the national trauma data bank: the more we look, the more we find.J Trauma. 2008; 64 (discussion 936-7): 932-936
- Insurance coverage of patients with breast cancer in the 1991 commission on cancer patient care evaluation study.Ann Surg Oncol. 1994; 1: 462-467
- The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States.Cancer. 1998; 83: 1262-1273
- Improving breast cancer care through a regional quality collaborative.Surgery. 2011; 150: 635-642
- Progress in the diagnosis of appendicitis: a report from Washington State's Surgical Care and Outcomes Assessment Program.Ann Surg. 2012; 256: 586-594
- Factors associated with stroke or death after carotid endarterectomy in Northern New England.J Vasc Surg. 2008; 48: 1139-1145
- A regional registry for quality assurance and improvement: the Vascular Study Group of Northern New England (VSGNNE).J Vasc Surg. 2007; 46 (discussion 1101-2): 1093-1101
- Risk-adjusted 30-day outcomes of carotid stenting and endarterectomy: results from the SVS Vascular Registry.J Vasc Surg. 2009; 49: 71-79
- First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass.Ann Surg. 2011; 254 (discussion 420-2): 410-420
- Differences in reported esophageal cancer resection outcomes between national clinical and administrative databases.J Thorac Cardiovasc Surg. 2012; 144: 1152-1157
- Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model.J Thorac Cardiovasc Surg. 2009; 137 (discussion 596): 587-595
- Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database.Surg Obes Relat Dis. 2010; 6: 347-355
- Partnering with payers to improve surgical quality: the Michigan plan.Surgery. 2005; 138: 815-820
- The Society for Vascular Surgery Vascular Quality Initiative.J Vasc Surg. 2012; 55: 1529-1537
- Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?.J Thorac Cardiovasc Surg. 2002; 123: 869-880
- Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial.J Am Med Assoc. 2003; 290: 49-56
- The Society of Thoracic Surgeons' National Cardiac Database: provider engagement in continuous quality improvement.Am Heart Hosp J. 2003; 1: 180-182
- A statewide quality collaborative for process improvement: internal mammary artery utilization.Ann Thorac Surg. 2010; 90 (discussion 1164): 1158-1164
- Cardiac surgeons and the quality movement: the Michigan experience.Semin Thorac Cardiovasc Surg. 2009; 21: 20-27
- Impact of internal mammary artery conduits on operative mortality in coronary revascularization.Ann Thorac Surg. 1994; 57: 27-32
- Transfusion rate as a quality metric: is blood conservation a learnable skill?.Ann Thorac Surg. 2013; 96: 1279-1286
- Morbidity but not mortality is decreased after off-pump coronary artery bypass surgery.Ann Thorac Surg. 2014; 97: 831-836
- Analyzing “failure to rescue”: is this an opportunity for outcome improvement in cardiac surgery?.Ann Thorac Surg. 2013; 95 (discussion 1981): 1976-1981
- Center-level variation in infection rates after coronary artery bypass grafting.Circ Cardiovasc Qual Outcomes. 2014; 7: 567-573
- Predicting risk-adjusted mortality for CABG surgery: logistic versus hierarchical logistic models.Med Care. 2005; 43: 726-735
- An examination of liver offers to candidates on the liver transplant wait-list.Gastroenterology. 2012; 143: 1261-1265
- Disparities in liver transplantation: the association between donor quality and recipient race/ethnicity and sex.Transplantation. 2014; 97: 862-869
- Association of center volume with outcome after liver and kidney transplantation.Am J Transplant. 2004; 4: 920-927
- Improving the Glasgow Coma Scale score: motor score alone is a better predictor.J Trauma. 2003; 54 (discussion 678-80): 671-678
- A trauma mortality prediction model based on the anatomic injury scale.Ann Surg. 2008; 247: 1041-1048
- The Survival Measurement and Reporting Trial for Trauma (SMARTT): background and study design.J Trauma. 2010; 68: 1491-1497
- Hospital performance in caring for injured patients: does the type of injury make a difference?.Arch Surg. 2009; 144: 1121-1126
- Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to improve surgical outcomes.J Am Coll Surg. 2012; 214 (discussion 714-6): 709-714
- The power of the National Surgical Quality Improvement Program–achieving a zero pneumonia rate in general surgery patients.Perm J. 2012; 16: 39-45
- The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri.Am J Surg. 2009; 198: S49-S55
- Multihospital collaborations for surgical quality improvement.J Am Med Assoc. 2009; 302: 1584-1585
- The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs.Arch Surg. 2002; 137: 20-27
- Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery.Ann Surg. 2010; 252: 345-350
- Analytic morphomics, core muscle size, and surgical outcomes.Ann Surg. 2012; 256: 255-261
- Abdominal aortic calcification and surgical outcomes in patients with no known cardiovascular risk factors.Ann Surg. 2013; 257: 774-781
- Surgical site infection and analytic morphometric assessment of body composition in patients undergoing midline laparotomy.J Am Coll Surg. 2011; 213: 236-244
- Risk factors for anastomotic leak and mortality in diabetic patients undergoing colectomy: analysis from a statewide surgical quality collaborative.Arch Surg. 2012; 147: 600-605
- Cost of major surgery in the sarcopenic patient.J Am Coll Surg. 2013; 217: 813-818
- Early outcomes of endovascular versus open abdominal aortic aneurysm repair in the National Surgical Quality Improvement Program-Private Sector (NSQIP-PS).J Vasc Surg. 2005; 41: 382-389
- Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP.J Am Coll Surg. 2011; 212: 844-854
- A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics.Ann Surg. 2010; 252 (discussion 519-20): 514-519
- Bowel preparation for colectomy and risk of Clostridium difficile infection.Dis Colon Rectum. 2011; 54: 810-817
- A statewide colectomy experience: the role of full bowel preparation in preventing surgical site infection.Ann Surg. 2014; 259: 310-314
- A statewide, community-based assessment of alvimopan's effect on surgical outcomes.Ann Surg. 2013; 257: 427-432
- Hospital readmissions after colectomy: a population-based study.J Am Coll Surg. 2013; 217: 1070-1079
- The importance of improving the quality of emergency surgery for a regional quality collaborative.Ann Surg. 2013; 257: 596-602
- Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery.Surgery. 2014; 155: 602-606
- Risk factors for morbidity and mortality after colectomy for colon cancer.Dis Colon Rectum. 2000; 43: 83-91
- Variation in hospital mortality associated with inpatient surgery.N Engl J Med. 2009; 361: 1368-1375
- Hospital morbidity rankings and complication severity in vascular surgery.J Vasc Surg. 2013; 57: 158-164
- Improving mortality following emergent surgery in older patients requires focus on complication rescue.Ann Surg. 2013; 258 (discussion 617-8): 614-617
- Failure to rescue and mortality following repair of abdominal aortic aneurysm.J Vasc Surg. 2014; 59: 909-914.e1
- Complication rates of ostomy surgery are high and vary significantly between hospitals.Dis Colon Rectum. 2014; 57: 632-637
- Improving the care of elderly adults undergoing surgery in Michigan.J Am Geriatr Soc. 2014; 62: 352-357
- Variation in ambulatory surgery utilization in Michigan.J Surg Res. 2014; 189: 255-261
- Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program.J Am Coll Surg. 2012; 214: 909-918.e1
- Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.Arch Surg. 2012; 147: 345-351
- Creating a learning healthcare system in surgery: Washington State's Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years.Surgery. 2012; 151: 146-152
- Factors associated with amputation or graft occlusion one year after lower extremity bypass in northern New England.Ann Vasc Surg. 2010; 24: 57-68
- Society for Vascular Surgery Vascular Registry evaluation of stent cell design on carotid artery stenting outcomes.J Vasc Surg. 2011; 54: 71-79
- Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by Medicare age.J Vasc Surg. 2012; 55 (discussion 1321): 1313-1320
- Society of vascular surgery vascular registry comparison of carotid artery stenting outcomes for atherosclerotic vs nonatherosclerotic carotid artery disease.J Vasc Surg. 2010; 51: 1116-1123
- Bariatric Outcomes Longitudinal Database (BOLD) suggests excess weight loss and excess BMI loss to be inappropriate outcome measures, demonstrating better alternatives.Obes Surg. 2012; 22: 1843-1847
- Use of bariatric outcomes longitudinal database (BOLD) to study variability in patient success after bariatric surgery.Obes Surg. 2014; 24: 936-943
- Influence of ethnicity on the efficacy and utilization of bariatric surgery in the USA.J Gastrointest Surg. 2014; 18: 130-136
- Is ambulatory laparoscopic Roux-en-Y gastric bypass associated with higher adverse events?.Ann Surg. 2014; 259: 286-292
- Hiatal hernia repair and gastroesophageal reflux disease in gastric banding patients: Analysis of a national database.Surg Obes Relat Dis. 2014; 10: 438-443
- Early outcomes of bariatric surgery in patients with metabolic syndrome: an analysis of the bariatric outcomes longitudinal database.J Am Coll Surg. 2012; 214 (discussion 556-7): 550-556
- Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the Bariatric Outcomes Longitudinal Database.Ann Surg. 2010; 252 (discussion 566-7): 559-566
- Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity.Arch Surg. 2012; 147: 847-854
- Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery.Arch Surg. 2012; 147: 994-998
- Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.Ann Surg. 2011; 254: 633-640
- Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative.Ann Surg. 2012; 255: 1100-1104
- Preoperative placement of inferior vena cava filters and outcomes after gastric bypass surgery.Ann Surg. 2010; 252: 313-318
- Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery.J Hosp Med. 2013; 8: 173-177
- Shorter circular staple is height associated with lower anastomotic stricture rate in laparoscopic gastric bypass.Surg Obes Relat Dis. 2012; 8: 181-184
- The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity.Ann Surg. 2013; 257: 791-797
- Composite measures for profiling hospitals on bariatric surgery performance.JAMA Surg. 2014; 149: 10-16
- Regional quality groups in the Society for Vascular Surgery® Vascular Quality Initiative.J Vasc Surg. 2013; 57: 884-890
- Factors associated with surgical site infection after lower extremity bypass in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI).J Vasc Surg. 2014; 60: 1238-1246
- A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group.J Am Med Assoc. 1996; 275: 841-846
- Improving the outcomes of coronary artery bypass surgery in New York State.J Am Med Assoc. 1994; 271: 761-766
- Effectiveness of nonpublic report cards for reducing trauma mortality.JAMA Surg. 2014; 149: 137-143
- 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
- How a regional collaborative of hospitals and physicians in Michigan cut costs and improved the quality of care.Health Aff (Millwood). 2011; 30: 636-645
- Trauma quality improvement using risk-adjusted outcomes.J Trauma. 2008; 64 (discussion 604-6): 599-604
- Hazards of benchmarking complications with the National Trauma Data Bank: numerators in search of denominators.J Trauma. 2008; 64 (discussion 277-9): 273-277
- Impact of statistical approaches for handling missing data on trauma center quality.Ann Surg. 2009; 249: 143-148
- Database comparison of the adult-to-adult living donor liver transplantation cohort study (A2ALL) and the SRTR U.S. Transplant Registry.Am J Transplant. 2010; 10: 1621-1633
- Reliability adjustment for reporting hospital outcomes with surgery.Ann Surg. 2012; 255: 703-707
- Composite measures for profiling hospitals on surgical morbidity.Ann Surg. 2013; 257: 67-72
- Reliability of risk-adjusted outcomes for profiling hospital surgical quality.JAMA Surg. 2014; 149: 467-474
- A quality assurance model of operative mortality in coronary artery surgery.Ann Thorac Surg. 1989; 47: 646-649
- Morbidity and mortality after colorectal procedures: comparison of data from the American College of Surgeons case log system and the ACS NSQIP.J Am Coll Surg. 2011; 212: 1077-1085
- Bias in the coding of hospital discharge data and its implications for quality assessment.Med Care. 1994; 32: 81-90
- Safety culture and complications after bariatric surgery.Ann Surg. 2013; 257: 260-265
- Surgical skill and complication rates after bariatric surgery.N Engl J Med. 2013; 369: 1434-1442
- Patients' perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS Hospital Survey.Ann Surg. 2014; 260: 5-9
- Cost-effectiveness of the National Surgical Quality Improvement Program.Ann Surg. 2011; 254: 619-624
- Relationship between occurrence of surgical complications and hospital finances.J Am Med Assoc. 2013; 309: 1599-1606
- Who pays for poor surgical quality? Building a business case for quality improvement.J Am Coll Surg. 2006; 202: 933-937
- The Michigan surgical quality collaborative: will a statewide quality improvement initiative pay for itself?.Ann Surg. 2007; 246: 1100-1103
- Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS).J Thorac Cardiovasc Surg. 1980; 80: 876-887
Article info
Publication history
Accepted:
August 26,
2014
Footnotes
Funding: A.M.S., A.D., G.D.S. time was supported for this publication by The Robert Wood Johnson Foundation Clinical Scholars program and the U.S. Department of Veterans Affairs Grant number 70039.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
