LAUSR

BACKGROUND Surgical quality improvement efforts are challenging due to the multi-disciplinary nature of care, difficulties obtaining reliable data, and variability in quality metrics. The objective of this analysis was to assess whether participation in a regional collaborative quality initiative was associated with decreased in-hospital surgical complications in South Carolina (SC). STUDY DESIGN In-hospital surgical complication rates were determined utilizing a statewide all payer claims data set. Retrospective, univariate, and longitudinal multivariable analyses were performed, and adjustments were made to account for aggregated hospital-level patient characteristics. RESULTS The analysis includes 275,387 general surgery cases performed in SC hospitals between January 2016 and December 2018. Eight hospitals involved in the South Carolina Surgical Quality Collaborative (SCSQC) performed 56,179 cases while 51 non-SCSQC hospitals performed 219,208 cases. Univariate analysis revealed SCSQC hospitals performed surgeries in older patients (p<0.0001) and patients with higher mean Charlson Comorbidity Scores (p<0.0001). SCSQC hospitals had higher mean in-hospital surgical complication rates at the surgery level compared to non-SCSQC hospitals (8.3% vs 7.0%, p<0.0001). However, in multivariable analyses the rate ratio for in-hospital surgical complications in SCSQC hospitals was 0.994 (95%CI, 0.989-0.998; p=0.008) per month compared to non-SCSQC hospitals. This suggests a 21.6% (95%CI, 7.2%-39.6%) proportional decrease in the rate of in-hospital surgical complications over three years associated with participation in the regional collaborative quality initiative. CONCLUSION Structured collaboration between facilities, reliable data abstraction support, timely data review, and active member participation resulted in outcome improvements for participating hospitals compared to hospitals that did not participate in a regional collaborative quality Initiative.