Generic versus disease-specific adverse event reporting: a comparison of the NSQIP and SAVES databases for the identification of acute care adverse events in adult spine surgery
Eryck Moskven
Eryck MoskvenDepartment of Orthopedic Surgery, Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia; and
乱发广告的准确识别和报告se events (AEs) is crucial for quality improvement. A myriad of AE systems are utilized. There is a lack of understanding of the differences between prospective versus retrospective, disease-specific versus generic, and point-of-care versus chart-abstracted systems. The objective of this study was to compare the benefits and limitations between the prospective, disease-specific, point-of-care Spine Adverse Events Severity System (SAVES) and the retrospective, generic, and chart-abstracted National Surgical Quality Improvement Program (NSQIP) for the identification and reporting of AEs in adult patients undergoing spinal surgery.
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The authors conducted an observational ambidirectional cohort study of adult patients undergoing spine surgery other than for trauma between 2011 and 2019 in a quaternary spine center. Patients were identified using Current Procedural Terminology codes in the NSQIP database and matched using unique medical record numbers to their corresponding record in SAVES. The incidence of AEs and per-patient AEs as recorded in NSQIP and SAVES was the primary outcome of interest. Comparable AEs were identified by matching NSQIP AEs to equivalent ones in SAVES. Chi-square tests were used to test for significant differences in the incidence of overall and comparable AEs between the databases.
RESULTS
There were 2198 patients identified in NSQIP, of whom 2033 also had complete records in SAVES. SAVES identified 5342 individual AEs in 1484 patients (73%) compared with 1291 individual AEs in 807 patients (39.7%) with the NSQIP database (p < 0.001). SAVES identified 250 intraoperative and 422 postoperative spine-specific AEs that NSQIP did not record. NSQIP captured a greater number of AEs beyond 30 days, including prolonged length of stay > 30 days, unplanned readmission, unplanned reoperation, and death later than 30 days after surgery compared with SAVES.
CONCLUSIONS
SAVES captures a greater incidence of peri- and intraoperative spine-specific AEs than NSQIP, while NSQIP identifies a greater number of AEs beyond 30 days. While a prospective, disease-specific, point-of-care AE system such as SAVES is specific for guiding quality improvement in spine surgery, it incurs greater time and financial costs. Conversely, a retrospective, generic, and chart-abstracted system such as NSQIP provides equivocal cross-institutional comparability with reduced time and financial costs. Specific contextual and aim-specific needs should guide the choice and implementation of an AE system.
ABBREVIATIONS
AE = adverse event;CPT = Current Procedural Terminology;dSSI = deep surgical site infection;DVT = deep vein thrombosis;FTE = full-time equivalent;ICD = International Classification of Diseases;LOS = length of stay;MRN = medical record number;NSQIP = National Surgical Quality Improvement Program;OR = operating room;PE = pulmonary embolism;SAVES = Spine Adverse Events Severity System;SCI = spinal cord injury;sSSI = superficial surgical site infection;UTI = urinary tract infection.
CorrespondenceEryck Moskven: University of British Columbia, Vancouver, BC, Canada.eryckmoskven@rcsi.ie.
INCLUDE WHEN CITINGPublished online April 28, 2023; DOI: 10.3171/2023.3.SPINE221437.
DisclosuresDr. Charest-Morin reported receiving grants paid to the institution from the North American Spine Society and AO Spine, and personal fees from Cerapedics for consulting, outside the submitted work. Dr. Dea reported personal fees from Medtronic, Baxter, Cerapedics, and Stryker, outside the submitted work. Dr. Fisher reported personal fees from Medtronic, and grants for fellowship support from AO Spine, Medtronic, and DePuy Synthes, outside the submitted work.
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