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Risk-adjusted hospital outcomes for children's surgery
Jacqueline M Saito1, Li Ern Chen, Bruce L Hall
1Division of Pediatric Surgery, Washington University, St. Louis, MO, USA.
Pediatrics
|August 7, 2013
Summary
The National Surgical Quality Improvement Program-Pediatric provides reliable models for assessing hospital performance in pediatric surgery, differentiating institutions based on composite morbidity and surgical site infections. Mortality data is less useful for performance comparison due to low event rates.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Surgical Outcomes Analysis
Background:
- The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) was established in 2008 to enhance quality in pediatric surgery.
- Previous analyses showed limited ability to differentiate hospital performance due to low mortality and morbidity rates.
Purpose of the Study:
- To develop and validate risk-adjusted models for assessing hospital performance in pediatric surgery.
- To identify key predictors of 30-day mortality and morbidity in pediatric surgical patients.
- To evaluate the utility of mortality and morbidity data for differentiating hospital performance.
Main Methods:
- Data from 43 children's hospitals (46,281 patients) in 2011 were analyzed.
- Hierarchical models incorporating procedure-specific risk were used to assess 30-day mortality and morbidity.
- Stepwise logistic regression identified significant predictors, and reliability estimates assessed model performance.
Main Results:
- Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%.
- Risk-adjusted models successfully identified outlier hospitals for composite morbidity and SSI.
- Mortality data demonstrated poor discrimination of hospital performance due to a low event rate.
Conclusions:
- The ACS NSQIP-P expansion provides effective risk-adjusted models for differentiating hospital performance in pediatric surgery based on morbidity.
- Mortality is not a reliable indicator for comparing hospital performance in pediatric surgery.
- The program generates actionable data for quality improvement initiatives.
