O. A. Sacks1, A. J. Lambour2, S. Nammalwar1, S. L. Wong1,2 1Dartmouth Medical School,Lebanon, NH, USA 2Dartmouth-Hitchcock Medical Center,Department Of Surgery,Lebanon, NH, USA
Introduction:
In recent years there has been a proliferation of surgical quality improvement (QI) work and a commensurate increase in the number of reports in the surgical literature. The Standards of Quality Improvement Reporting Excellence (SQUIRE) guidelines were developed and disseminated (version 2.0 was released in 2015) to systematize and improve QI study design and reporting. We performed a systematic review of the surgical QI literature to assess the quality of QI reporting.
Methods:
We completed a systematic review of the surgical QI literature between 2008-2018, limited to publications in the top 30 surgical journals and the top 20 general interest journals based on impact factor. Inclusion criteria included English language studies, an identifiable surgical QI intervention, and measurement of quality. Papers were reviewed for concordance with the SQUIRE statements using a dichotomous (y/n) scale. Evaluation was organized both by the 18 main SQUIRE statements and their 40 subheadings.
Results:
1480 abstracts were identified in the initial literature search and 58 articles met the inclusion criteria. No articles were completely adherent to the SQUIRE guidelines. On average, QI publications met just 10/18 (56%) of the main statements and 24/40 (60%) of the subheading topics. Generally, the articles were concordant with components such as “Problem Description” (58/58, 100%), “Rationale” (56/58, 97%), and “Specific Aims” (55/58, 95%). Publications lacked a general description of methodology: only 41 publications adequately described the “Intervention” and only 26 described the measures chosen to assess the processes and outcomes of that intervention (“Study of the Intervention”) (71% and 45%, respectively). Very few articles (22/58, 38%) satisfactorily reported the “Results” and only 29 (29/58, 50%) articles listed the key findings and strengths of the project (“Summary”) (Figure). In total, only 7 articles cited the SQUIRE guidelines (7/58, 12%). Papers that cited SQUIRE were compliant with a mean of 26/40 (65%) statements, compared to 24/40 (60%) statements for those that did not cite SQUIRE (p=0.82). Most of the papers that cited SQUIRE (5/7, 71%) were published after the release of SQUIRE 2.0.
Conclusion:
The quality of surgical QI reporting is relatively poor. Our analysis demonstrates that the SQUIRE guidelines have not been widely adopted as a framework for the reporting of surgical QI studies. Increased adherence to the SQUIRE guidelines has the potential to meaningfully improve the development and dissemination of surgical QI projects.
