Abstract
Background
The National Surgical Quality Improvement Program (NSQIP) database is increasingly
used for surgical research. However, it is unclear how well this database represents
the breadth of work performed by different specialties.
Methods
Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier
Procedure Summary file, we evaluated (1) what proportion of surgical work is captured
by NSQIP, (2) what procedures and disciplines are undersampled, and (3) the overall
concordance between the NSQIP sample and a national sample.
Results
The NSQIP database reported at least one case for 4,463 out of the 5,272 Current Procedures
Terminology codes in the Medicare file, potentially capturing 97.8% of surgical work
across all 10 specialties. However, this proportion decreased to 72.1% when only procedures
with at least 100 cases in NSQIP were considered. Limiting our analysis to only those
procedures with 100 cases had markedly different effects by specialty. In part, this
was owing to undersampling of minor procedures, which are more common in disciplines
such as otolaryngology and urology. The overall association between the size of the
NSQIP sample and the Medicare sample was 0.08.
Conclusion
Although NSQIP has the potential to capture a diverse surgical caseload, some specialties
and procedures are undersampled, limiting the ability for NSQIP to generate valid
benchmarks. There was little correlation between the sample sizes in NSQIP and a national
sample. Increasing sampling of underrepresented procedures and developing weights
to scale NSQIP to a national sample would strengthen the program's ability to inform
health outcomes research and provide valid comparisons across procedures and specialties.
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Article info
Publication history
Published online: December 19, 2019
Accepted:
November 12,
2019
Footnotes
Amber B. Tang and Christopher P. Childers are co-first authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
