Using the National Surgical Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes Oscar D Guillamondegui, MD, MPH, FACS, Oliver L Gunter, MD, FACS, Leonard Hines, MD, FACS, Barbara J Martin, RN, MBA, William Gibson, MD, P. Chris Clarke, RN, BSN, William T. Cecil, MBA, Joseph B Cofer, MD, FACS BACKGROUND: Led by the Tennessee Chapter of the American College of Surgeons, in May 2008 a 10-hospital collaborative was formed between the Tennessee Chapter of ACS, the Tennessee Hospital Association, and the BlueCross BlueShield of Tennessee Health Foundation. We hypothesized that by forming the Tennessee Surgical Quality Collaborative using the National Surgical Quality Improvement Program (NSQIP) system to share surgical process and outcomes data, overall patient surgical outcomes would improve. STUDY DESIGN: All NSQIP data from the 10-hospital collaborative for the time periods January to December 2009 (period 1) and January to December 2010 (period 2) were collected. Data on 20 categories of postoperative complications and 30-day mortality were compared between periods. Com- plication comparisons and hospital costs associated with complications were calculated per 10,000 procedures. Statistical analysis was performed by Z-test. RESULTS: There were 14,205 total surgical cases in period 1 and 14,901 surgical cases in period 2. Between periods (per 10,000 cases) there were significant improvements in superficial surgical site infections (19%, p  0.0005), on ventilator longer than 48 hours (15%, p  0.012), graft/prosthesis/flap failure (60%, p  0.0001), acute renal failure (25%, p  0.023), and wound disruption (34%, p  0.011). Although mortality (per 10,000) was higher in period 2 (237.6 vs 232.3), no statistical difference was noted. Net costs avoided between these periods were calculated as $2,197,543 per 10,000 general and vascular surgery cases. CONCLUSIONS: Data organization and scrutiny are the initial steps of process improvement. Participation in our regional surgical quality collaborative resulted in improved outcomes and reduced costs. Al- though the mechanisms for these changes are likely multifactorial, the collaborative establishes communication, process improvement, and frank discussion among the members as best prac- tices are identified and shared and standardized processes are adopted. (J Am Coll Surg 2012;xx: xxx. © 2012 by the American College of Surgeons) Surgery has long been a rapidly evolving field that has been affected by multiple factors including information technol- ogy, improved understanding of anatomy and physiology, and maturation of health care systems. As the rapid changes have slowed into a plateau phase, the focus is shifting from development and application of novel procedures to the standardization of outcomes. The current era of surgery depends heavily on complex health care delivery systems that must remain plastic in order to optimize outcomes. Although constantly minimizing practice variability by us- ing practice management guidelines has been advocated and is deeply ingrained into current health care delivery models, 1 implementation of evidence-based medicine is frequently dependent on local culture and resources. There is rarely a “one-size-fits-all” solution that solves some of the Disclosure Information: Nothing to disclose. Presented at the Southern Surgical Association 123rd Annual Meeting, Hot Springs, VA, December 2011. Received December 5, 2011; Accepted December 15, 2011. From the Department of Surgery, Vanderbilt University Medical Center (Guillamondegui, Gunter, Martin); the Tennessee Valley Healthcare System, Veteran’s Affairs (Guillamondegui); and the Tennessee Hospital Association (Clarke, Cecil), Nashville, TN; the Department of Surgery, University of Tennessee Graduate School of Medicine (Hines) and Premier Surgical Asso- ciates, Parkwest Medical Center (Gibson), Knoxville, TN; and the Depart- ment of Surgery, University ofTennessee College of Medicine-Chattanooga, Chattanooga, TN (Cofer). Correspondence address: Joseph B Cofer, MD, FACS, Department of Sur- gery, Suite 401, 979 E Third St, Chattanooga, TN 37403. email: joe. cofer@erlanger.org 1 © 2012 by the American College of Surgeons ISSN 1072-7515/12/$36.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2011.12.012