Comparing short-term AIS post-operative complications between ACS-NSQIP and a surgeon study group.
STUDY DESIGN
Prospective cohort review.


OBJECTIVE
To compare two AIS databases to determine if a performance improvement-based surgeon group has different outcomes compared to a national database. The American College of Surgeon's National Quality Improvement Program (ACS-NSQIP) and a surgeon study group (SG) collect prospective data on AIS surgery outcomes. NSQIP offers open enrollment to all institutions, and SG membership is limited to 15 high-volume institutions, with a major initiative to improve surgeon performance. While both provide important outcome benchmarks, they may reflect outcomes that are not relatable nationwide.


METHODS
The ASC-NSQIP Pediatric Spine Fusion and SG database were queried for AIS 30- and 90-day complication data for 2014 and 2015. Prospective enrollment and a dedicated site coordinator with rigorous data quality assurance protocols existed for both registries. Outcomes were compared between groups with respect to superficial and deep surgical site infections (SSI), neurologic injury, readmission, and reoperation.


RESULTS
There were a total of 2927 AIS patients included in the ASC-NSQIP data and 721 in the SG database. Total complication rate was 9.4% NSQIP and 3.6% SG. At 90 days, there were fewer surgical site infections reported by SG than ASC-NSQIP (0.6% vs. 1.6%, p = 0.03). Similarly, there were less spinal cord injuries (0.8% vs 1.5%, p = 0.006), 30-day readmissions (0.8% vs. 2.6%, p = 0.002), and 30-day reoperations (0.6% vs. 1.7%, p = 0.02) in the SG cohort.


CONCLUSIONS
Comparison of these two data sets suggests a range of complications and readmission rates, with the SG demonstrating lower values. These results are likely multi-factorial with the performance improvement initiative of the SG playing a role. Understanding the rate and ultimate risk factors for readmission and complications from big data sources has the potential to further drive quality improvement.


LEVEL OF EVIDENCE
III.
['Bauer|Jennifer M|JM|http://orcid.org/0000-0001-5326-8383', 'Shah|Suken A|SA|', 'Sponseller|Paul D|PD|', 'Samdani|Amer F|AF|', 'Newton|Peter O|PO|', 'Marks|Michelle C|MC|', 'Lonner|Baron S|BS|', 'Yaszay|Burt|B|', '|||']
D000293:Adolescent D002648:Child D002983:Clinical Competence D016208:Databases, Factual D005260:Female D006801:Humans D008297:Male D010359:Patient Readmission D011183:Postoperative Complications D011446:Prospective Studies D011785:Quality Assurance, Health Care D058996:Quality Improvement D011787:Quality of Health Care D012307:Risk Factors D012600:Scoliosis D013119:Spinal Cord Injuries D013123:Spinal Fusion D066231:Surgeons D013997:Time Factors D016896:Treatment Outcome
AIS NSQIP Pediatric spine fusion Pediatric scoliosis Spine complications