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Pediatric National Surgical Quality Improvement Program: Useful for Quality Improvement in Craniosynostosis Surgery?
Sandi Lam1, Jared Fridley, Virendra R Desai
1Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
Insights
This study analyzed pediatric craniosynostosis surgery outcomes using the Pediatric National Surgical Quality Improvement Program (NSQIP Peds) database. Longer surgery and anesthesia durations were linked to increased blood transfusion needs.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Quality Improvement
Background:
- Craniosynostosis surgery in children requires careful monitoring of outcomes.
- The Pediatric National Surgical Quality Improvement Program (NSQIP Peds) offers valuable data for assessing surgical quality.
- Understanding perioperative events and transfusion needs is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To describe 30-day outcomes for pediatric craniosynostosis surgery.
- To identify associations between clinical factors, perioperative events, and blood transfusion.
- To evaluate the utility of the Pediatric NSQIP Peds database for craniosynostosis surgery analysis.
Main Methods:
- Utilized the national multicenter Pediatric NSQIP Peds database.
- Examined 572 pediatric craniosynostosis surgeries.
- Analyzed associations between clinical risk factors and outcomes like perioperative complications and blood transfusion.
Main Results:
- The study included 572 surgeries; 67% received blood transfusions.
- The perioperative adverse event rate was 3.15%, including infection and readmission.
- Longer surgical duration and anesthesia time were significant risk factors for blood transfusion.
Conclusions:
- Pediatric NSQIP Peds provides a national overview of craniosynostosis surgery outcomes.
- Surgery duration and anesthesia time are key factors associated with blood transfusion requirements.
- Opportunities exist for enhancing the Pediatric NSQIP database for future research.
Abstract:
The American College of Surgeons and the American Pediatric Surgical Association collaborate to provide pediatric hospitals with multispeciality surgical outcomes data through the Pediatric National Surgical Quality Improvement Program (NSQIP Peds). The authors used this national multicenter database to describe 30-day outcomes from craniosynostosis surgery and identify associations with perioperative events and blood transfusion.Data from NSQIP Peds were used to describe children undergoing craniosynostosis surgery. The authors examined statistical association of clinical risk factors with the defined end point outcomes of perioperative complications and blood transfusion.Five hundred seventy-two surgeries were included. By Common Procedural Terminology codes, 93 identified as single suture synostosis, the remainder as multiple or unknown suture involvement. Location of the affected suture is not captured. Mean surgical time was 196.84 minutes (SD 113.46). Mean length of stay was 4.22 days (SD 5.04). Sixty-seven percent of patients received blood transfusions. 3.15% were other perioperative occurrences, including infection, wound disruption, unplanned reintubation, stroke/hemorrhage, cardiac arrest, seizures, thromboembolism. 2.8% were readmitted; 2.45% underwent reoperation within 30 days. Duration of surgery and length of hospital stay significantly differed in the presence of blood transfusion versus none. On multivariate analysis, duration from anesthesia start to surgery start, duration from surgery end to anesthesia end, and duration of operation were risk factors for blood transfusion.Pediatric NSQIP gives a national overview of 30-day outcome metrics in craniosynostosis surgery. Perioperative adverse event rate was 3.15%. Duration of surgery and duration of anesthesia were significantly associated with blood transfusion. The authors identified opportunities for pediatric NSQIP database improvement.
