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Retained foreign bodies and associated risk factors and outcomes in pediatric surgical patients
Angelina L Schwartz1, Maziar M Nourian1, Brian T Bucher1
1Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, United States.
Insights
Retained foreign bodies (RFB) after surgery are a patient safety concern. Pediatric patients undergoing emergent procedures, especially in interventional radiology, face higher RFB risks, leading to longer hospital stays but not increased mortality.
Area of Science:
- Pediatric Surgery
- Patient Safety
- Health Services Research
Background:
- Retained foreign bodies (RFB) after surgery are recognized patient safety indicators by the Agency for Health Care Quality and Research (AHRQ).
- Identifying pediatric-specific risk factors and outcomes associated with RFB is crucial for improving patient care.
Purpose of the Study:
- To identify pediatric patient and procedure risk factors for retained foreign bodies (RFB).
- To determine the outcomes associated with RFB in pediatric surgical patients.
Main Methods:
- Retrospective case-control study utilizing the Pediatric Health Information System (PHIS) database.
- Patients with RFB were identified using AHRQ Patient Safety Indicator (PSI) definitions.
- Controls were matched 5:1 on age, procedure date, and hospital; secondary outcomes included length of stay and mortality.
Main Results:
- Pediatric patients with RFB frequently had emergent procedures, chronic conditions, and required ICU admission or mechanical ventilation.
- Musculoskeletal procedures accounted for the highest number of RFB cases (30.4%), while interventional radiology procedures showed significantly higher odds of RFB (AOR 7.88).
- Children with RFB experienced a 4-day increase in hospital length of stay (p < .001) but no significant difference in mortality (p = .579).
Conclusions:
- Administrative flags can be utilized to identify pediatric patients at higher risk for retained foreign bodies.
- Early identification and prevention strategies are essential to mitigate the primary problem and sequelae of RFB in children.
Background:
Retained foreign bodies discovered after surgery are documented as Agency for Health Care Quality and Research Patient Safety Indicators. Our goal was to identify pediatric patient and procedure risk factors and outcomes associated with RFB based on AHRQ Definitions.
Methods:
We performed a retrospective case-control study of children with RFB using the PHIS database. Patients were defined as having RFB based on the AHRQ PSI definition. Controls were matched in a 5:1 ratio on age, procedure date, and hospital. Our primary outcome was the presence of RFB. Secondary outcomes included hospital length of stay and mortality.
Results:
Patients with RFB often underwent emergent procedures, experienced one or more chronic conditions, and required ICU admission or mechanical ventilation. Musculoskeletal procedures contribute the largest numbers of RFB (30.4%), but interventional radiology procedures had higher odds of having RFB (AOR 7.88, p < 0.0001). After multivariate adjustment, children with RFB required 4 more days of hospitalization (p < .001), but there was no difference in mortality (p = .579).
Conclusions:
The implications of our study include identifying which administrative flags can be used to identify children at higher risks for RFB. Early identification of at-risk patients and prevention are key towards addressing the primary problem and corresponding sequela of RFB.
Levels Of Evidence:
Prognostic Study Level III.
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