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This JAMA Guide to Statistics and Methods summarizes the National Surgical Quality Improvement Program (NSQIP) and its pediatric offshoot for use in surgical research.

For more than 100 years, the American College of Surgeons (ACS) has set the standard for the delivery of high-quality medical and surgical care. Based on programs originally created at the US Department of Veterans Affairs, the ACS developed and implemented the National Surgical Quality Improvement Program (NSQIP) in 2004.1 Since its inception, the NSQIP has spread to nearly 700 hospitals and captures more than 1 million incident cases annually.

A major strength of the ACS NSQIP program is the means that it provides to report national, clinically abstracted, highly reliable, risk-adjusted, and case-mix–adjusted surgical data that facilitates validated peer-comparison. As such, the ACS NSQIP is widely recognized as the premier surgical quality and outcomes assessment program (Box 8). Via the ACS NSQIP, hospitals and clinicians have access to granular, actionable data that have led to improvements in morbidity and mortality, cost savings from prevention of complications, and a platform for disease-specific, procedure-specific, or regional or system-based collaboratives.

BOX 8 Best Practices for Using NSQIP Data

  1. Identify a hypothesis-driven question and ensure that the NSQIP data set is the appropriate source to address questions on the target population and outcomes.

  2. Secure data access and examine all variables and outcomes for definition continuity over time.

  3. Define an analytic plan to appropriately exclude preexisting conditions, account for missing data, and risk adjust for comorbidities and procedural case mix.

  4. Perform sensitivity analyses to address confounding.

  5. Interpret results understanding the limitations related to missing clinician-level and hospital-level clustering of outcomes, length of follow-up periods, and generalizability beyond the hospitals participating in the program.

Abbreviation: NSQIP, National Surgical Quality of Improvement Program.

In parallel, the ACS NSQIP Pediatric (NSQIP-P) program was piloted in 2008 to address surgical quality improvement for children undergoing surgery.2 The ACS NSQIP-P now includes more than 100 sites and captures more than 150 000 pediatric cases annually.


Access and Logistics

More than 1500 peer-reviewed articles associated with the use of ACS NSQIP data have been published. Researchers can access the data through a Health Insurance Portability and Accountability Act-compliant Participant Use File (PUF) ( Pending approval and permission by local administration and quality leaders, PUF access incurs no cost to researchers at a participating ACS NSQIP hospital. While the PUF contains deidentified patient-level aggregate data, the ACS does not provide hospital or clinician identifiers. In addition, there is a data use agreement that prohibits the attempted identification of patients, clinicians, or hospitals. The PUFs are available by calendar year or as separate procedure-targeted PUFs. Procedure-targeted PUFs contain unique procedure-specific variables based on center participation.

Variables and Outcomes


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