Clin Colon Rectal Surg 2019; 32(01): 041-053
DOI: 10.1055/s-0038-1673353
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery

Samuel Eisenstein
1   Section of Colon and Rectal Surgery, Rebecca and John Moores Cancer Center, University of California San Diego Health, La Jolla, California
Sarah Stringfield
1   Section of Colon and Rectal Surgery, Rebecca and John Moores Cancer Center, University of California San Diego Health, La Jolla, California
Stefan D. Holubar
2   Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2019 (online)


The American College of Surgeons' National Surgical Quality Improvement Project (ACS-NSQIP) is probably the most well-known surgical database in North American and worldwide. This clinical database was first proposed by Dr. Clifford Ko, a colorectal surgeon, to the ACS, and NSQIP first started collecting data ca. 2005 with the intent of comparing hospitals (benchmarking) and for hospital-level quality improvement projects. Since then, its popularity has grown from just a few participating hospitals in the United States to more than 708 participating hospitals worldwide, and collaboration allows regional or disease-specific data sharing. Importantly, from a methodological perspective, as the number of hospitals has grown so has the hospital heterogeneity and thus generalizability of the results and conclusions of the individual studies. In this article, we will first briefly present the structure of the database (aka the Participant User File) and other important methodological considerations specific to performing clinical research. We will then briefly review and summarize the approximately 60 published colectomy articles and 30 published articles on proctectomy. We will conclude with future directions relevant to colorectal clinical research.

  • References

  • 1 Bilimoria KY, Bentrem DJ, Merkow RP. , et al. Laparoscopic-assisted vs. open colectomy for cancer: comparison of short-term outcomes from 121 hospitals. J Gastrointest Surg 2008; 12 (11) 2001-2009
  • 2 Ricciardi R, Roberts PL, Read TE, Hall JF, Marcello PW, Schoetz DJ. Which adverse events are associated with mortality and prolonged length of stay following colorectal surgery?. J Gastrointest Surg 2013; 17 (08) 1485-1493
  • 3 Ingraham AM, Cohen ME, Bilimoria KY. , et al. Comparison of hospital performance in nonemergency versus emergency colorectal operations at 142 hospitals. J Am Coll Surg 2010; 210 (02) 155-165
  • 4 Ballian N, Weisensel N, Rajamanickam V. , et al. Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP. World J Surg 2012; 36 (10) 2488-2496
  • 5 Holubar SD, Brickman RK, Greaves SW, Ivatury SJ. Neoadjuvant radiotherapy: a risk factor for short-term wound complications after radical resection for rectal cancer?. J Am Coll Surg 2016; 223 (02) 291-298
  • 6 Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg 2015; 262 (02) 331-337
  • 7 Haskins IN, Fleshman JW, Amdur RL, Agarwal S. The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients. J Surg Oncol 2016; 114 (07) 810-813
  • 8 Kiran RP, Murray ACA, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262 (03) 416-425 , discussion 423–425
  • 9 Moghadamyeghaneh Z, Hwang GS, Hanna MH. , et al. Risk factors for prolonged ileus following colon surgery. Surg Endosc 2016; 30 (02) 603-609
  • 10 Tevis SE, Carchman EH, Foley EF, Harms BA, Heise CP, Kennedy GD. Postoperative ileus--more than just prolonged length of stay?. J Gastrointest Surg 2015; 19 (09) 1684-1690
  • 11 Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Nguyen NT, Stamos MJ. A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg 2014; 18 (12) 2169-2177
  • 12 Greaves SW, Holubar SD. Preoperative hospitalization is independently associated with increased risk for venous thromboembolism in patients undergoing colorectal surgery: a National Surgical Quality Improvement Program database study. Dis Colon Rectum 2015; 58 (08) 782-791
  • 13 Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes?. J Am Coll Surg 2011; 212 (02) 187-194
  • 14 Sippey M, Spaniolas K, Manwaring ML, Pofahl WE, Kasten KR. Surgical resident involvement differentially affects patient outcomes in laparoscopic and open colectomy for malignancy. Am J Surg 2016; 211 (06) 1026-1034
  • 15 Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 2010; 211 (02) 232-238
  • 16 Stefanou AJ, Reickert CA, Velanovich V, Falvo A, Rubinfeld I. Laparoscopic colectomy significantly decreases length of stay compared with open operation. Surg Endosc 2012; 26 (01) 144-148
  • 17 Webb S, Rubinfeld I, Velanovich V, Horst HM, Reickert C. Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy. Surg Endosc 2012; 26 (03) 732-737
  • 18 Mustain WC, Davenport DL, Hourigan JS, Vargas HD. Obesity and laparoscopic colectomy: outcomes from the ACS-NSQIP database. Dis Colon Rectum 2012; 55 (04) 429-435
  • 19 Isik O, Aytac E, Ashburn J. , et al. Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Surg Endosc 2015; 29 (05) 1039-1044
  • 20 Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ. Hand-assisted laparoscopic approach in colon surgery. J Gastrointest Surg 2015; 19 (11) 2045-2053
  • 21 Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK. A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 2016; 30 (04) 1576-1584
  • 22 Miller PE, Dao H, Paluvoi N. , et al. Comparison of 30-day postoperative outcomes after laparoscopic vs robotic colectomy. J Am Coll Surg 2016; 223 (02) 369-373
  • 23 Greenblatt DY, Rajamanickam V, Pugely AJ, Heise CP, Foley EF, Kennedy GD. Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg 2011; 212 (05) 844-854
  • 24 Nurkin S, Kakarla VR, Ruiz DE, Cance WG, Tiszenkel HI. The role of faecal diversion in low rectal cancer: a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma. Colorectal Dis 2013; 15 (06) e309-e316
  • 25 Kwaan MR, Al-Refaie WB, Parsons HM, Chow CJ, Rothenberger DA, Habermann EB. Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database. JAMA Surg 2013; 148 (06) 504-510
  • 26 Nfonsam V, Aziz H, Pandit V, Khalil M, Jandova J, Joseph B. Analyzing clinical outcomes in laparoscopic right vs. left colectomy in colon cancer patients using the NSQIP database. Cancer Treat Commun 2016; 8: 1-4
  • 27 Yeo H, Mao J, Abelson JS. , et al. Development of a nonparametric predictive model for readmission risk in elderly adults after colon and rectal cancer surgery. J Am Geriatr Soc 2016; 64 (11) e125-e130
  • 28 Causey MW, Nelson D, Johnson EK. , et al. An NSQIP evaluation of practice patterns and outcomes following surgery for anorectal abscess and fistula in patients with and without Crohn's disease. Gastroenterol Rep (Oxf) 2013; 1 (01) 58-63
  • 29 Papageorge CM, Zhao Q, Foley EF. , et al. Short-term outcomes of minimally invasive versus open colectomy for colon cancer. J Surg Res 2016; 204 (01) 83-93
  • 30 Haskins IN, Baginsky M, Amdur RL, Agarwal S. Preoperative hypoalbuminemia is associated with worse outcomes in colon cancer patients. Clin Nutr 2017; 36 (05) 1333-1338
  • 31 Wallaert JB, De Martino RR, Marsicovetere PS. , et al. Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum 2012; 55 (11) 1138-1144
  • 32 Wilson MZ, Connelly TM, Tinsley A, Hollenbeak CS, Koltun WA, Messaris E. Ulcerative colitis is associated with an increased risk of venous thromboembolism in the postoperative period: the results of a matched cohort analysis. Ann Surg 2015; 261 (06) 1160-1166
  • 33 Wideroff M, Xing Y, Liao J, Byrn JC. Crohn's disease but not diverticulitis is an independent risk factor for surgical site infections in colectomy. J Gastrointest Surg 2014; 18 (10) 1817-1823
  • 34 Nguyen GC, Elnahas A, Jackson TD. The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease. J Crohn's Colitis 2014; 8 (12) 1661-1667
  • 35 Geltzeiler CB, Young JI, Diggs BS. , et al. Strictureplasty for treatment of Crohn's disease: an ACS-NSQIP database analysis. J Gastrointest Surg 2015; 19 (05) 905-910
  • 36 Gunnells Jr DJ, Morris MS, DeRussy A. , et al. Racial disparities in readmissions for patients with inflammatory bowel disease (IBD) after colorectal surgery. J Gastrointest Surg 2016; 20 (05) 985-993
  • 37 Arsoniadis EG, Ho Y-Y, Melton GB, Madoff RD, Le C, Kwaan MR. African Americans and short-term outcomes after surgery for Crohn's disease: an ACS-NSQIP analysis. J Crohn's Colitis 2017; 11 (04) 468-473
  • 38 Wertzberger BE, Sherman SK, Byrn JC. Differences in short-term outcomes among patients undergoing IPAA with or without preoperative radiation: a National Surgical Quality Improvement Program analysis. Dis Colon Rectum 2014; 57 (10) 1188-1194
  • 39 Kakarla VR, Nurkin SJ, Sharma S, Ruiz DE, Tiszenkel H. Elective laparoscopic versus open colectomy for diverticulosis: an analysis of ACS-NSQIP database. Surg Endosc 2012; 26 (07) 1837-1842
  • 40 Wise KB, Merchea A, Cima RR, Colibaseanu DT, Thomsen KM, Habermann EB. Proximal intestinal diversion is associated with increased morbidity in patients undergoing elective colectomy for diverticular disease: an ACS-NSQIP study. J Gastrointest Surg 2015; 19 (03) 535-542
  • 41 Papageorge CM, Kennedy GD, Carchman EH. National trends in short-term outcomes following non-emergent surgery for diverticular disease. J Gastrointest Surg 2016; 20 (07) 1376-1387
  • 42 Al-Khamis A, Abou Khalil J, Demian M. , et al. Sigmoid colectomy for acute diverticulitis in immunosuppressed vs immunocompetent patients: outcomes from the ACS-NSQIP database. Dis Colon Rectum 2016; 59 (02) 101-109
  • 43 Gawlick U, Nirula R. Resection and primary anastomosis with proximal diversion instead of Hartmann's: evolving the management of diverticulitis using NSQIP data. J Trauma Acute Care Surg 2012; 72 (04) 807-814 , quiz 1124
  • 44 Arkenbosch J, Miyagaki H, Kumara HM, Yan X, Cekic V, Whelan RL. Efficacy of laparoscopic-assisted approach for reversal of Hartmann's procedure: results from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Surg Endosc 2015; 29 (08) 2109-2114
  • 45 Clark III CE, Jupiter DC, Thomas JS, Papaconstantinou HT. Rectal prolapse in the elderly: trends in surgical management and outcomes from the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg 2012; 215 (05) 709-714
  • 46 Fang SH, Cromwell JW, Wilkins KB. , et al. Is the abdominal repair of rectal prolapse safer than perineal repair in the highest risk patients? An NSQIP analysis. Dis Colon Rectum 2012; 55 (11) 1167-1172
  • 47 Thiels CA, Shenoy CC, Ubl DS, Habermann EB, Kelley SR, Mathis KL. Rates, trends, and short-term outcomes of colorectal resections for endometriosis: an ACS-NSQIP review. Int J Surg 2016; 31: 5-9
  • 48 Shubert CR, Habermann EB, Bergquist JR. , et al. A NSQIP review of major morbidity and mortality of synchronous liver resection for colorectal metastasis stratified by extent of liver resection and type of colorectal resection. J Gastrointest Surg 2015; 19 (11) 1982-1994
  • 49 Kwaan MR, Melton GB, Madoff RD, Chipman JG. Abdominoperineal resection, pelvic exenteration, and additional organ resection increase the risk of surgical site infection after elective colorectal surgery: an American College of Surgeons National Surgical Quality Improvement Program analysis. Surg Infect (Larchmt) 2015; 16 (06) 675-683
  • 50 Harris JW, Martin JT, Maynard EC, McGrath PC, Tzeng C-WD. Increased morbidity and mortality of a concomitant colectomy during a pancreaticoduodenectomy: an NSQIP propensity-score matched analysis. HPB 2015; 17 (09) 846-854
  • 51 Hassan I, Pacheco PE, Markwell SJ, Ahad S. Additional procedures performed during elective colon surgery and their adverse impact on postoperative outcomes. J Gastrointest Surg 2015; 19 (03) 527-534
  • 52 Paquette IM, Swenson BR, Kwaan MR, Mellgren AF, Madoff RD. Thirty-day outcomes in patients treated with en bloc colectomy and pancreatectomy for locally advanced carcinoma of the colon. J Gastrointest Surg 2012; 16 (03) 581-586
  • 53 Kwok AC, Lipsitz SR, Bader AM, Gawande AA. Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly. J Am Coll Surg 2011; 213 (02) 220-225
  • 54 Neale JA, Reickert C, Swartz A, Reddy S, Abbas MA, Rubinfeld I. Accuracy of national surgery quality improvement program models in predicting postoperative morbidity in patients undergoing colectomy. Perm J 2014; 18 (01) 14-18
  • 55 Ju MH, Ko CY, Hall BL, Bosk CL, Bilimoria KY, Wick EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015; 150 (01) 51-57
  • 56 Bergquist JR, Thiels CA, Etzioni DA, Habermann EB, Cima RR. Failure of colorectal surgical site infection predictive models applied to an independent dataset: do they add value or just confusion?. J Am Coll Surg 2016; 222 (04) 431-438