Faculty Collaboration Database

A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough? J Pediatr Surg 2016 Apr;51(4):639-44

Date

11/23/2015

Pubmed ID

26590473

DOI

10.1016/j.jpedsurg.2015.10.046

Scopus ID

2-s2.0-84963944115 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND/PURPOSE: Surgical wound classification (SWC) is widely utilized for surgical site infection (SSI) risk stratification and hospital comparisons. We previously demonstrated that nearly half of common pediatric operations are incorrectly classified in eleven hospitals. We aimed to improve multicenter, intraoperative SWC assignment through targeted quality improvement (QI) interventions.

METHODS: A before-and-after study from 2011-2014 at eleven children's hospitals was conducted. The SWC recorded in the hospital's intraoperative record (hospital-based SWC) was compared to the SWC assigned by a surgeon reviewer utilizing a standardized algorithm. Study centers independently performed QI interventions. Agreement between the hospital-based and surgeon SWC was analyzed with Cohen's weighted kappa and chi square.

RESULTS: Surgeons reviewed 2034 cases from 2011 (Period 1) and 1998 cases from 2013 (Period 2). Overall SWC agreement improved from 56% to 76% (p<0.01) and weighted kappa from 0.45 (95% CI 0.42-0.48) to 0.73 (95% CI 0.70-0.75). Median (range) improvement per institution was 23% (7-35%). A dose-response-like pattern was found between the number of interventions implemented and the amount of improvement in SWC agreement at each institution.

CONCLUSIONS: Intraoperative SWC assignment significantly improved after resource-intensive, multifaceted interventions. However, inaccurate wound classification still commonly occurred. SWC used in SSI risk-stratification models for hospital comparisons should be carefully evaluated.

Author List

Putnam LR, Levy SM, Blakely ML, Lally KP, Wyrick DL, Dassinger MS, Russell RT, Huang EY, Vogel AM, Streck CJ, Kawaguchi AL, Calkins CM, St Peter SD, Abbas PI, Lopez ME, Tsao K, Pediatric Surgical Research Collaborative

Author

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Algorithms
Child
Decision Support Techniques
Hospitals, Pediatric
Humans
Intraoperative Care
Longitudinal Studies
Quality Improvement
Risk Assessment
Surgical Wound
Surgical Wound Infection
United States