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American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report. J Pediatr Surg 2013 Jan;48(1):74-80 PMID: 23331796

Pubmed ID

23331796

DOI

10.1016/j.jpedsurg.2012.10.019

Abstract

PURPOSE: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons.

METHODS: Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals.

RESULTS: During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers.

CONCLUSION: This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.

Author List

Bruny JL, Hall BL, Barnhart DC, Billmire DF, Dias MS, Dillon PW, Fisher C, Heiss KF, Hennrikus WL, Ko CY, Moss L, Oldham KT, Richards KE, Shah R, Vinocur CD, Ziegler MM

Author

Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84872410547   83 Citations

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

Child
Child, Preschool
Humans
Infant
Infant, Newborn
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Pediatrics
Postoperative Complications
Program Development
Program Evaluation
Quality Improvement
Retrospective Studies
Risk Adjustment
Specialties, Surgical
Surgical Procedures, Operative
Surgical Wound Infection
United States
jenkins-FCD Prod-333 a62a3a22e9ea2608e6e5d74170cf1523726e0e5b