Validation of the ACS-NSQIP Liver Module: A Single-Center Experience

Introduction: Large centralized databases are being increasingly utilized to assess surgical outcomes and determine reimbursement. The accuracy of liver resection data within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is assessed.Methods: From August 2007 to May 2013, a retrospective review of liver resections captured by single-institution "standard" ACS-NSQIP data and a prospectively-maintained database was performed.Results: Of the 93 liver resections captured by ACS-NSQIP, 12 were incorrectly classified (false positive rate, 12.9%).Of the 81 true liver resections reported (139 actually performed), ACS-NSQIP demonstrated high fidelity with the prospective database with respect to preoperative characteristics, median length of surgical stay (6 days, interquartile range: 4-7 days vs. 6 days, IQR: 4-7 days), and 30-day mortality (1.2% vs. 1.2%).The "standard" ACS-NSQIP underreported the overall complication rate (29.6% vs. 43.2%;P < 0.001) and failed to capture liver-specific complications including biliary leak, liver failure, pleural effusion, postoperative ascites, and small bowel obstruction (overall sensitivity, 68.6%). Conclusions:Overall reporting of liver resection data within ACS-NSQIP is generally robust.While the ACS-NSQIP Procedure-Targeted program for liver resection instituted in 2012 would capture the majority of liver-specific complications, further refinement may improve the accuracy of this database.