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American College of Surgeons National Surgical Quality Improvement Program Pediatric: a phase 1 report
Mehul V Raval1, Peter W Dillon, Jennifer L Bruny
1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. m-raval@md.northwestern.edu
Insights
The American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP Pediatric) shows potential for improving children's surgical care. Key factors influencing postoperative complications include inpatient procedures, nutritional status, and pre-existing conditions.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Healthcare Outcomes Research
Background:
- A need exists for a multi-institutional, multispecialty program focused on improving surgical quality for pediatric patients.
- The American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP Pediatric) was developed to address this need.
Purpose of the Study:
- To document the results of the initial phase of the ACS-NSQIP Pediatric program.
- To identify factors associated with postoperative occurrences in pediatric surgical patients.
Main Methods:
- A cohort of 7,287 pediatric patients from 4 referral centers was sampled between October 2008 and December 2009.
- Methodology from the American College of Surgeons National Surgical Quality Improvement Program was adapted for pediatric surgical care.
Main Results:
- The overall mortality rate was 0.3%, with 3.9% of patients experiencing postoperative occurrences.
- Inpatient procedures (OR = 4.71), compromised physiologic status (OR = 1.68), and American Society of Anesthesiologists (ASA) classification 4/5 (OR = 5.74) were associated with increased occurrences.
- Complication rates varied significantly by surgical specialty, ranging from 1.5% in otolaryngology to 9.0% in neurosurgery.
Conclusions:
- The ACS-NSQIP Pediatric program demonstrates potential for identifying pediatric surgical outcomes amenable to quality improvement efforts.
- Further development and application of this program can lead to enhanced patient safety and care for children undergoing surgery.
Background:
There has been a long-standing desire to implement a multi-institutional, multispecialty program to address surgical quality improvement for children. This report documents results of the initial phase of the American College of Surgeons National Surgical Quality Improvement Program Pediatric.
Study Design:
From October 2008 to December 2009, patients from 4 pediatric referral centers were sampled using American College of Surgeons National Surgical Quality Improvement Program methodology tailored to children.
Results:
A total of 7,287 patients were sampled, representing general/thoracic surgery (n = 2,237; 30.7%), otolaryngology (n = 1,687; 23.2%), orthopaedic surgery (n = 1,367; 18.8%), urology (n = 893; 12.3%), neurosurgery (n = 697; 9.6%), and plastic surgery (n = 406; 5.6%). Overall mortality rate detected was 0.3% and 287 (3.9%) patients had postoperative occurrences. After accounting for demographic, preoperative, and operative factors, occurrences were 4 times more likely in those undergoing inpatient versus outpatient procedures (odds ratio [OR] = 4.71; 95% CI, 3.01-7.35). Other factors associated with higher likelihood of postoperative occurrences included nutritional/immune history, such as preoperative weight loss/chronic steroid use (OR = 1.49; 95% CI, 1.03-2.15), as well as physiologic compromise, such as sepsis/inotrope use before surgery (OR = 1.68; 95% CI, 1.10-1.95). Operative factors associated with occurrences included multiple procedures under the same anesthetic (OR = 1.58; 95% CI, 1.21-2.06) and American Society of Anesthesiologists classification category 4/5 versus 1 (OR = 5.74; 95% CI, 2.94-11.24). Specialty complication rates varied from 1.5% for otolaryngology to 9.0% for neurosurgery (p < 0.001), with specific procedural groupings within each specialty accounting for the majority of complications. Although infectious complications were the predominant outcomes identified across all specialties, distribution of complications varied by specialty.
Conclusions:
Based on this initial phase of development, the highly anticipated American College of Surgeons National Surgical Quality Improvement Program Pediatric has the potential to identify outcomes of children's surgical care that can be targeted for quality improvement efforts.