ACS NSQIP Surgical Risk Calculator: Pilot Analysis on Feasibility in an Academic Safety Net Hospital.

Area of Science:

• Health Services Research
• Surgical Quality Improvement
• Healthcare Data Analytics

Background:

• Hospitals need effective risk-adjusted outcome tracking, especially safety net hospitals (SNHs) serving high-risk populations.
• Quality-based reimbursement incentives necessitate robust data for accurate patient risk assessment.
• The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) aims to standardize surgical quality auditing.

Purpose of the Study:

• To determine the presence and consistency of data required for the ACS NSQIP risk calculator in preoperative documentation at an urban academic SNH.
• To evaluate the completeness of charting for perioperative risk assessment in a high-volume SNH setting.

Main Methods:

• Retrospective chart review of 28 elective colorectal procedures at an urban academic SNH over one year.
• Assessment of preoperative documentation for the presence of required ACS NSQIP variables.
• Univariate and bivariate statistical analysis to compare data field completion rates.

Main Results:

• None of the 28 reviewed charts contained all preoperative risk documentation for ACS NSQIP risk analysis.
• 89.3% of charts had 55% or less of the required data for risk assessment.
• Demographic variables were more frequently recorded than other risk factors (P < 0.001).

Conclusions:

• Preoperative risk assessment and charting practices at the reviewed SNH were fragmented and incomplete.
• There was a lack of definitive documentation for risk factors and preoperative interventions.
• Institutions should critically evaluate their documentation practices, particularly in light of reimbursement models like MACRA.