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Risk-adjusted hospital outcomes for children's surgery. Pediatrics 2013 Sep;132(3):e677-88 PMID: 23918898

Pubmed ID

23918898

DOI

10.1542/peds.2013-0867

Abstract

UNLABELLED: BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance.

METHODS: Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models.

RESULTS: In 2011, 46‚ÄČ281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible.

CONCLUSIONS: The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in actionable data.

Author List

Saito JM, Chen LE, Hall BL, Kraemer K, Barnhart DC, Byrd C, Cohen ME, Fei C, Heiss KF, Huffman K, Ko CY, Latus M, Meara JG, Oldham KT, Raval MV, Richards KE, Shah RK, Sutton LC, Vinocur CD, Moss RL

Author

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




Scopus

2-s2.0-84884574850   55 Citations

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

Adolescent
Cause of Death
Child
Child, Preschool
Current Procedural Terminology
Female
Hospital Mortality
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Logistic Models
Male
Models, Statistical
Postoperative Complications
Prospective Studies
Quality Improvement
Risk Adjustment
United States
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5