Back to 2024 Abstracts
Adding Patient-Reported Outcomes to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP): Results of the First 33,842 Patients from 65 Hospitals
*Jason B. Liu1, Andrea L. Pusic
1 , *Alexa D. Melucci
2 , *Matt Fordham
3 , *Jakob Lapsley
3 , Clifford Y. Ko
3 , Larissa K. Temple
3
1 Surgery, Brigham and Women’s Hospital, Boston, MA; 2 Surgery, University of Rochester Medical Center, Rochester, NY;3 American College of Surgeons, Chicago, IL.
Objective(s): Recognizing the role of patient-reported outcomes (PROs) in quality assessment and improvement, the ACS conducted a project to determine the feasibility of collecting PROs into the NSQIP using an electronic platform. We report the first results of adding PROs in a national cohort of ACS NSQIP patients, including the influence of postoperative complications on patient scores.
Methods: From 2/2020-3/2023, 65 NSQIP hospitals collected 4 PROMIS measures to assess physical function, fatigue, pain interference, and mental quality of life (QoL). Each patient’s PROs were linked to their respective NSQIP data. To compare PROs of patients with and without 30-day morbidity, reoperation, or readmission, we estimated adjusted mean differences using multivariable mixed regression accounting for patient- and case-mix. We also compared PROMIS scores in surgical patients to the national population and evaluated patients with and without any complications who also reported PROs one standard deviation (1-SD) or more below the national average.
Results: Overall, 33842 patients with median age 65 years (IQR 54-72) reported PROs a median 58 days (IQR 47-72) postoperatively, of which 20640 (61.0%) were female, 3901 (11.5%) Black, 17433 (51.5%) ASA Physical Status 3/4, and 21015 (62.1%) procedures were outpatient. The five most common procedures were knee replacement (3141; 9.3%), hysterectomy (2865, 8.5%), colorectal operations (2561, 7.6%), hernia repair (2554, 7.5%), and hip replacement (2111, 6.2%). Morbidity, reoperation, and readmission occurred in 1592 (4.7%), 613 (1.8%), and 1268 (3.8%) patients, respectively. Though no complications occurred in 31210 (92.2%) patients, 10586 (33.9%) had PROs 1-SD or more below the national average and were more often older, morbidly obese, and with more comorbidities. Adjusting for patient- and case-mix, patients who experienced postoperative morbidity, compared to those without, had significantly worse physical function (adjusted mean difference 3.0, 95% confidence interval 2.5-3.4,
p<0.001), fatigue (2.7, 2.2-3.3,
p<0.001), pain interference (2.3, 1.8-2.8,
p<0.001), and mental QoL (1.9, 1.4-2.4,
p<0.001). Similar significant differences between patients with and without readmission and/or reoperation were evident on all PROMIS measures. Adjusting for patient- and case-mix, patients with any complication had 1.7-times greater odds (95% CI 1.6-1.8;
p<0.001) of reporting PROs 1-SD or more below the national average.
Conclusions: In this NSQIP study, patients with complications reported statistically and clinically poorer PROs. In addition, over 30% of patients without complications reported below-average PROs independent of procedure type. Identifying solutions to improve PROs after surgery remains a quality opportunity. This study shows the necessity of incorporating PROs into the quality assessment for patients undergoing a wide selection of surgical operations.
Back to 2024 Abstracts
