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Hospital and procedure incidence of pediatric retained surgical items
Bo Wang1, Jun Tashiro1, Eduardo A Perez1
1Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Insights
Retained surgical item (RSI) rates in children decreased after the World Health Organization Safe Surgery guidelines. Public and nonteaching hospitals saw the largest reductions, while private hospitals experienced an increase.
Area of Science:
- Pediatric Surgery
- Patient Safety
- Healthcare Quality Improvement
Background:
- Retained surgical items (RSIs) are a significant patient safety concern.
- The World Health Organization (WHO) established "Guidelines for Safe Surgery" (GSS) in 2008 to prevent RSIs.
- Improving patient safety by preventing RSIs is a primary objective of surgical guidelines.
Purpose of the Study:
- To analyze trends in RSI incidence among pediatric patients before and after the implementation of the WHO/GSS.
- To identify specific hospital characteristics and procedures associated with higher RSI rates.
Main Methods:
- Analysis of the Kids' Inpatient Database (1997-2009) for pediatric patients (<18 years) with RSIs.
- Calculation of RSI incidence per 100,000 admissions and procedures.
- Stratification of RSI rates by hospital bed size, teaching status, ownership, region, and location (rural/metropolitan).
Main Results:
- Overall RSI rates decreased post-WHO/GSS implementation (2.22/100,000 admissions, 1.93/100,000 procedures).
- Public and nonteaching hospitals showed the most significant RSI rate reductions.
- Private (nonprofit) hospitals reported an increase in RSI rates post-WHO/GSS.
- Fundoplications and gastric procedures were associated with the highest RSI rates.
Conclusions:
- The WHO/GSS have contributed to an overall reduction in pediatric RSIs.
- Disparities in RSI reduction exist across different hospital types, with private hospitals showing an increase.
- Specific procedures like fundoplications require targeted prevention strategies to reduce RSI events.
Background:
Prevention of retained surgical items (RSIs) is the main objective of the World Health Organization "Guidelines for Safe Surgery" (WHO/GSS) 2008 to improve patient safety.
Methods:
We analyzed Kids' Inpatient Database 1997-2009 for RSI in patients aged <18 y. Incidence of RSI was calculated by per 100,000 admissions and per 100,000 procedures. The incidence was analyzed based on hospital bedsize, teaching status, region, and ownership and rural versus metropolitan location based on per 100,000 admissions.
Results:
Overall, 713 cases were identified with a mean (standard deviation) age of 8.31 y (6.62), length of stay of 13 d (20), and total charges of $91,321 (155,054). RSI occurred at a rate of 2.22 per 100,000 admissions and 1.93 per 100,000 procedures; both rates decreased post-WHO/GSS implementation versus pre-WHO/GSS, P < 0.005. On average, public or children's hospitals reported the highest RSI rates (8.89 and 6.07/100,000 admissions, respectively). Small and medium bedsize hospitals had lower rates of RSI post-WHO/GSS, P < 0.05. Nonteaching, non-children's, or public hospitals reported lower rates post-WHO/GSS, P < 0.003. Private (nonprofit) hospitals reported higher rates post-WHO/GSS, P < 0.001. Facilities in the southern United States or in metropolitan areas reported lower rates post-WHO/GSS, P < 0.02. A subanalysis of 107 cases requiring surgical removal demonstrated that fundoplications had the highest rate of RSI, followed by gastric procedures, laparotomy, bile duct procedures, lysis of adhesions, and abdominal wall repair.
Conclusions:
RSI rates have decreased overall after the introduction of the WHO/GSS. The largest reductions have occurred in public or nonteaching hospitals. Only private (nonprofit) hospitals reported increases in RSI since 2008. Higher rates of RSI are associated with fundoplications and other gastric procedures.
