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Evaluating metrics for quality: death on the same day of elective pediatric surgery
David C Chang1, Daniel S Rhee, Yiyi Zhang
1University of California San Diego School of Medicine, CA, USA.
Insights
Same-day death in pediatric surgery is rare, occurring in 2.1 per 10,000 cases. While infrequent, this metric can aid quality improvement efforts by identifying cases for root-cause analysis.
Area of Science:
- Pediatric Surgery
- Healthcare Quality
- Patient Safety
Background:
- Surgical mortality is a key indicator of healthcare quality.
- Same-day death after elective pediatric surgery is considered a preventable event.
Purpose of the Study:
- To quantify the incidence of death on the day of elective pediatric surgery.
- To analyze same-day mortality rates across different surgical specialties and demographics.
Main Methods:
- Retrospective analysis of national state inpatient databases (1988-2007).
- Inclusion of elective pediatric surgical patients.
- Descriptive analysis of same-day mortality.
Main Results:
- 174 deaths occurred on the day of surgery among 835,880 cases (2.1 deaths/10,000).
- Mortality rates varied significantly by surgical specialty, from 0.06 (otolaryngology) to 17.4 (cardiothoracic surgery) per 10,000 cases.
Conclusions:
- Death on the day of elective pediatric surgery is a rare event.
- This metric's rarity limits its use for comparing pediatric surgery performance.
- Same-day mortality can serve as a valuable case-finding tool for quality improvement and root-cause analysis at institutional levels.
Abstract:
Surgical mortality is considered a benchmark for measuring quality of care. This study quantifies the incidence of death on the day of elective pediatric surgery, which generally is considered preventable and might be considered a "never" event. The authors conducted a retrospective analysis of national state inpatient databases from 1988 to 2007 that included elective pediatric surgical patients. A descriptive analysis of same-day mortality by demographics, surgical specialties, and age was performed. Of 835 880 elective pediatric surgical cases identified, 174 patients died on the day of surgery-that is, 2.1 deaths/10 000 cases. Surgical specialty mortality rates ranged from 0.06 (otolaryngology) to 17.4 (cardiothoracic surgery) deaths per 10 000 cases. Death on the day of elective pediatric surgery is rare, limiting its utility to compare performance in pediatric surgery. However, this metric may be useful at individual institutions as a case-finding tool for root-cause analysis in quality improvement efforts.