Wound classification in pediatric general surgery: significant variation exists among providers

Area of Science:

• Healthcare Quality Improvement
• Surgical Patient Safety
• Medical Data Analysis

Background:

• Surgical site infection (SSI) rates are key quality metrics, often utilizing risk-adjusted models.
• The NSQIP-Pediatric database uses surgical wound classification to predict postoperative morbidity, including SSIs.
• Accurate wound classification is essential for reliable quality assessment and comparative analysis.

Purpose of the Study:

• To assess agreement in surgical wound classification among surgeons, operating room (OR) nurses, and NSQIP surgical clinical reviewers (SCR).
• To identify variations in wound classification assignment across different healthcare providers.
• To evaluate the impact of provider type on classification consistency.

Main Methods:

• Analysis of pediatric general surgery operations from 2010-2011.
• Wound classification assigned by OR nurse, surgeon, and post-operative NSQIP SCR.
• Agreement assessed using the kappa statistic, with disagreement defined as any discrepancy.

Main Results:

• Overall disagreement among the three provider groups was 48% (kappa 0.48).
• Surgeon and NSQIP SCR agreement was higher at 77% (kappa 0.74), while OR nurse agreement was lower (38-40%).
• Highest disagreement rates observed in fundoplication (73%), appendectomy (71%), and cholecystectomy (60%).

Conclusions:

• Significant variation exists in surgical wound classification assignment among healthcare providers.
• This variability can affect the accuracy of quality metrics and comparative analyses.
• Standardizing wound classification procedures is vital for future SSI research and quality improvement initiatives.