Utilization and Performance Benchmarking for Postoperative Imaging in Children With Complicated Appendicitis: Results...

Area of Science:

• Pediatric Surgery
• Radiology
• Healthcare Quality Improvement

Background:

• Previous studies noted variation in preoperative imaging for appendicitis.
• Postoperative imaging use and accuracy for diagnosing organ space infection (OSI) after appendectomy in children remain uncharacterized.

Purpose of the Study:

• To characterize hospital-level variation in postoperative imaging for complicated appendicitis in children.
• To establish diagnostic performance benchmarks for postoperative imaging in this patient group.

Main Methods:

• Multicenter retrospective analysis of 1316 children undergoing appendectomy for complicated appendicitis.
• Data from NSQIP-Pediatric Appendectomy Pilot Collaborative analyzed for imaging rates (ultrasound, CT), diagnostic efficiency ratio (DER), and radiation stewardship metrics.
• Hospital-level observed-to-expected ratios (O/Es) calculated using multivariable regression.

Main Results:

• Significant hospital variation observed in postoperative imaging rates (4.8%-33.3%) and imaging DER (0-1.00).
• Wide variation in ultrasound utilization and CT scans preceded by ultrasound (27.3% overall).
• Fifty percent of hospitals were outliers in at least one imaging metric.

Conclusions:

• Substantial hospital-level variation exists in imaging practices for diagnosing OSI post-appendectomy.
• Imaging utilization benchmarking can guide quality improvement initiatives for resource optimization and radiation stewardship.