The Perioperative Quality Improvement Programme (PQIP Patient Study): Protocol for a UK Multicentre, Prospective Cohort Study to Measure, Report and Improve Quality and Outcomes of Major Surgery
Authors: Moonesinghe S. Ramani , McGuckin Dermot , Martin Peter , Bedford James , Wagstaff Duncan , Vindrola-Padros Cecilia , Sahni Arun , Edwards Kylie , Singleton Georgina , Singh Pritam , Wilson R.Jonathan T. , Gilhooly David Anthony , Baumber Rachel , Bougeard Anne-Marie , Samuel Katie , Brent Alexandra , Chazapis Maria , Cripps Martin , Dorey Jenny , Leeman Irene , Smith Helena , Swart Michael , Drake Sharon , Goodwin James , Lourtie Jose , Martinez Dorian , Olive Dominic , Taylor Christine , Williams Karen , Santos Cristel , Ellicott Helen , Warnakulasuriya Samantha , Ignacka Aleksandra , Bedford Matthew , Aresu Giuseppe , Tucker Olga , Vallance Abigail E , Vohra Ravinder , Swift Andrew , Fulop Naomi J , Grocott Michael PW 
Published: July 2021

Abstract
Background

Major surgery accounts for a substantial proportion of health service activity and resource consumption, due not only to the primary procedure, but also the short and long-term implications of perioperative complications. It is likely that both compliance with best practice processes and outcomes from major surgery vary substantially between hospitals and therefore could be targets for quality improvement.
Methods

The Perioperative Quality Improvement Programme (PQIP) patient study is a multi-centre prospective cohort study which recruits participants undergoing major inpatient non-cardiac surgery with three main aims: to measure and improve processes of care and outcome from major surgery; to implement and evaluate a complex intervention aiming to enhance the use of data for improvement by clinical teams; and to create a national database to support collaborative research and efficient study design. The prospective dataset combines variables for risk adjustment, process measures and both objective and patient reported outcome data. Longer-term outcomes are collected through linkage to national administrative datasets (mortality and readmissions). PQIP deploys a theoretically underpinned improvement methodology to support the use of data for improvement by perioperative clinicians, incorporating action research principles to enable changes to be made in response to user feedback. Dissemination of interim findings (non-inferential) form a part of the improvement methodology and are provided to participating centres at regular intervals, including near-real-time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a multi-modal communications strategy to patients, public, policy makers and academic audiences as well as clinicians.
Discussion

PQIP is the first national effort in the UK to measure and report risk-adjusted complications, patient-reported outcome and mortality rates for patients undergoing major surgery across multiple surgical specialties in the UK. Its main limitation is the risk of sampling bias due to the requirement for patient consent, and because local resource constraints may lead hospitals to recruit a convenience sample, rather than a truly random sample. We will evaluate this risk by using Hospital Episode Statistics (HES) to identify all patients undergoing PQIP eligible procedures, and undertaking sensitivity analyses comparing common data points in the PQIP sample and the HES population. As the purpose of PQIP is to support quality improvement and research as opposed to quality assurance or institutional comparisons, even if they exist, such sampling biases are unlikely to materially affect the ability of the programme to achieve its aims.