Focusing Quality Improvement Initiatives in Pediatric Plastic Surgery: A Descriptive Study Using the Pediatric
Susan J Flath-Sporn1, Rachel R Yorlets, Shawn J Rangel
1*Department of Plastic and Oral Surgery †Department of General Surgery, Boston Children's Hospital, Boston, MA ‡Department of General Surgery, Mount Sinai Medical Center, New York, NY §Division of Plastic and Reconstructive Surgery, Johns Hopkins Health System, Baltimore, MD ||Children's Hospital Los Angeles, Plastic and Maxillofacial Surgery, Los Angeles, CA.
Insights
Pediatric plastic surgery quality improvement should target high-volume, high-morbidity procedures. Cleft lip and palate surgeries are key areas for improving patient safety and outcomes.
Area of Science:
- Pediatric Plastic Surgery
- Surgical Quality Improvement
- Healthcare Outcomes Research
Background:
- The American College of Surgeons National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) employs risk-adjusted methodologies for hospital surgical performance comparison.
- This study identifies high-volume, high-morbidity diagnoses in pediatric plastic surgery to direct quality improvement initiatives.
Purpose of the Study:
- To pinpoint specific diagnoses within pediatric plastic surgery that warrant focused quality improvement efforts.
- To analyze patient data to identify procedures with significant volume and adverse event rates.
Main Methods:
- Utilized frequency statistics from the NSQIP-P database.
- Analyzed data for pediatric patients (<18 years) undergoing plastic surgery between January 2011 and December 2012.
Main Results:
- Cleft lip and palate procedures were the primary drivers of serious adverse events (45.00%).
- These procedures also significantly contributed to composite morbidity (37.73%) and hospital-acquired infections (21.23%).
Conclusions:
- Quality improvement efforts should prioritize procedures with both high patient volume and significant morbidity.
- Cleft lip and/or palate procedures represent a prime opportunity for coordinated quality improvement in pediatric plastic surgery.
- Balancing data collection feasibility with relevance is crucial for effective resource allocation.
Background:
The American College of Surgeons National Surgical Quality Improvement Program - Pediatrics uses a risk-adjusted, case-mix-adjusted methodology to compare quality of hospital-level surgical performance. This paper aims to focus quality improvement efforts on diagnoses that have large patient volume and high morbidity for pediatric plastic surgery.
Methods:
Frequency statistics were generated for a cohort of patients under age 18 who underwent plastic surgery procedures at participating National Surgical Quality Improvement Program - Pediatrics hospitals from January 1, 2011 to December 31, 2012.
Results:
Cleft lip and palate procedures were the leading contributor to serious adverse events (45.00%), and the second largest contributor to composite morbidity (37.73%) as well as hospital-acquired infections (21.23%).
Conclusions:
When focusing resources for relevant data collection and quality improvement efforts, it is important to consider procedures that are both substantial volume and result in relatively higher morbidity. A balance must be made between what is relevant to collect and what is feasible given finite resources. Cleft lip and/or palate procedures might provide an ideal opportunity for coordinated efforts that could ultimately improve care for pediatric plastic surgery patients.
