World Journal of Surgery

, Volume 43, Issue 2, pp 331–338 | Cite as

Reducing Healthcare Costs Using ACS NSQIP-Driven Quality Improvement Projects: A Success Story from Sheikh Khalifa Medical City (SKMC)

  • Abdelrahman A. NimeriEmail author
  • Jejomar Bautista
  • Ruby Philip
Original Scientific Report



Surgical complications increase hospital length of stay and costs and lead to poor patient experience. We aim to evaluate our complication rates over time and the financial impact of joining the adult multi-specialty American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) at Sheikh Khalifa Medical City (SKMC).


Sheikh Khalifa Medical City is a Joint Commission International-accredited ACS NSQIP member since 2009. For the purpose of quality improvement, we have established several task forces (2010–2014) to decrease high rates of venous thromboembolism (VTE), urinary tract infection (UTI), surgical site infection (SSI), unplanned intubation (UI), and ventilator more than 48 h (Vent > 48 h). Our aim is to evaluate our complication rates over time and calculate the cost savings from prevented occurrences in VTE, UTI, SSI, UI, and Vent > 48 h. Cost savings are calculated using the return on investment calculator from ACS NSQIP. In addition, the cost of joining and maintaining ACS NSQIP at SKMC is calculated to determine the total cost savings after subtracting these costs.


During the study period, we performed 8842 cases (2009–2015) and our overall morbidity improved significantly from observed/expected (O/E) 1.61% to (O/E) 0.85%. We prevented 12 VTE cases (2011–2015), 56 UTI cases (2013–2015), 12 SSI cases (2013–2015), 4 UI cases (2014–2015), and 7 Vent > 48 h cases (2014–2015). The cost saving from all these four task forces was $1,680,000. The cost of joining and maintaining ACS NSQIP at SKMC since 2009 was $336,000. Hence, the total saving for SKMC was $1,344,000.


ACS NSQIP-driven quality improvement projects have resulted in reduction in complications and healthcare costs at SKMC over a 6-year period.



American College of Surgeon National Surgical Quality Improvement Program


Venous thromboembolism


Surgical site infection


Urinary tract infection


Unplanned intubation

Vent > 48 h

Ventilator > 48 h


Return on investment



We would like to thank the chairs of the quality improvement committees, chairs of surgery, and our previous SCRs (Nidal Dehni, Ahmed Maasher, David Spence, Michel Bussieres, Mohamed Hobeldin, Zoe Barrat, and Karen Mckenna).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with the human participants or animals performed by any of the authors. For this type of study, formal consent is not required.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Abdelrahman A. Nimeri
    • 1
    • 2
    • 3
    Email author
  • Jejomar Bautista
    • 1
  • Ruby Philip
    • 1
  1. 1.Surgery InstituteSheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
  2. 2.Bariatric and Metabolic Institute Abu DhabiSheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
  3. 3.Division of General, Thoracic and Vascular SurgerySheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates

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