T.S. Kashikar1, A.A. Willette1, B.S. Shah1, D.C. Evans1 1OhioHealth Grant Medical Center, Trauma And Surgical Services, Columbus, OH, USA
Introduction: Cholecystectomy is one of most common operations performed by our acute care surgery (ACS) service and carries an elevated risk of complications in the emergent setting. We aimed to evaluate risk-adjusted outcomes in our patient population and identify areas of focus for future quality improvement. The ACS NSQIP risk calculator provides individualized risks of adverse outcomes within the 30-days following surgery using data gathered from the larger NSQIP dataset. The purpose of this project was to utilize the NSQIP risk calculator to compare our patients’ predicted and actual risk of complications and determine the feasibility of using the NSQIP risk calculator to perform a focused quality improvement project. As our hospital does not participate in the NSQIP program, we do not benefit from regular risk-adjusted surgical quality reporting and sought to perform a “spot check” of our program’s performance.
Methods: This was an IRB-exempt quality improvement project approved by the Clinical Performance Improvement Committee. We included all patients that underwent emergent cholecystectomy in 2023 by acute care surgeons. Patients were excluded if cholecystectomy was elective or they underwent incidental cholecystectomy for indications unrelated to a biliary pathology. The NSQIP risk calculator was used to calculate the predicted risk of adverse outcomes. Mean predicted risk was compared with actual rates of complication. Outcomes of interest were serious complication, any complication, surgical site infection (SSI), 30-day readmission, return to OR, and length of stay (LOS). Outcomes at our institution were compared with the predicted rates of complication from the NSQIP risk calculator for six major outcomes provided by NSQIP.
Results: 195 patients met our study criteria and were included in the final analysis. We had similar rates of serious complication and SSI, however we had significantly higher than expected rates of any complication and LOS. Interestingly, post-operative bile leak was the leading cause of readmission within 30 days of surgery.
Conclusion: Comparing our institution’s actual and predicted rates of post-operative complications after cholecystectomies performed in the acute care surgery setting allowed us to identify areas to investigate further. It is feasible to use the ACS NSQIP risk calculator to inform future quality improvement projects and obtain predicted complication rates that permit risk-adjusted outcomes analysis. A major limitation is that without NSQIP participation our audit lacks coding training and data validation that the program provides.