Wound classification in pediatric surgical procedures: Measured and found wanting

Area of Science:

• Pediatric Surgery
• Surgical Quality Improvement
• Infection Control

Background:

• Surgical wound classification is a key metric for assessing surgical care quality.
• Limited data exist on its applicability to pediatric minimally invasive procedures.
• This study addresses the gap in understanding surgical site infection (SSI) rates in children.

Purpose of the Study:

• To analyze the surgical site infection (SSI) rate based on wound classification in common pediatric surgical procedures.
• To evaluate the current wound classification system's effectiveness in pediatric surgical care.
• To investigate reoperation and readmission rates in relation to surgical complexity.

Main Methods:

• Retrospective analysis of the 2013 Pediatric-National Surgical Quality Improvement Program (Peds-NSQIP) dataset.
• Inclusion of patients undergoing pyloromyotomy, cholecystectomy, ostomy reversal, and appendectomy.
• Analysis of wound classification, SSI rates, reoperations, and readmissions.

Main Results:

• A total of 10,424 pediatric surgical cases were analyzed.
• SSI rates varied: clean (pyloromyotomy) 0.7%, clean-contaminated (ostomy reversal) 6.9%, contaminated (appendectomy/cholecystectomy) 2.1% to <1%, and dirty (perforated appendicitis) 9.1%.
• The SSI rate for perforated appendicitis was notably lower than expected for dirty procedures; reoperation and readmission rates increased with complexity.

Conclusions:

• Existing wound classification systems may not accurately reflect surgical risk in pediatric patients.
• These systems are questionable for benchmarking surgical quality in children.
• Further research is needed on the role of readmissions and reoperations as quality indicators in pediatric surgery.