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Quality metrics for emergency abdominal surgery in children: a systematic review
Lisa A Sogbodjor1, Georgina Singleton2, Mark Davenport3
1Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Insights
Quality metrics for pediatric emergency abdominal surgery are crucial. This systematic review identified key structural and process measures, like hospital caseload and timely interventions, linked to better patient outcomes, particularly for appendicitis.
Area of Science:
- Pediatric Surgery
- Quality Improvement
- Healthcare Outcomes
Background:
- Variations in care quality and outcomes exist for children undergoing emergency abdominal surgery.
- Paediatric-specific quality metrics are needed to address these variations.
- This study focuses on identifying perioperative factors influencing outcomes in pediatric emergency abdominal surgery.
Purpose of the Study:
- To identify perioperative structure and process measures associated with improved outcomes in children undergoing emergency abdominal surgery.
- To inform the development of quality improvement initiatives in pediatric surgical care.
Main Methods:
- Systematic review of literature from 1980 to 2020, searching multiple databases (MEDLINE, Embase, CINAHL, Cochrane Library, Google Scholar).
- Inclusion of peer-reviewed articles and grey literature, with secondary searching of references and citations.
- Analysis of international professional publications related to perioperative care in pediatric emergency abdominal surgery.
Main Results:
- Limited high-grade evidence exists for perioperative care in this patient group.
- Diagnostic accuracy measures (blood tests, imaging, decision tools) are frequently reported.
- Key processes include minimizing time to surgery and using specific analgesia/antibiotic protocols.
- Structural factors such as hospital/surgeon caseload and care pathways are associated with outcomes.
Conclusions:
- Structural and process measures associated with outcomes in pediatric emergency abdominal surgery have been summarized.
- These measures can be used to evaluate care and identify areas for quality improvement.
- Particular focus is placed on improving outcomes for children with appendicitis.
Background:
There is variation in care quality and outcomes for children undergoing emergency abdominal surgery, such as appedectomy. Addressing this requires paediatric-specific quality metrics. The aim of this study was to identify perioperative structure and process measures that are associated with improved outcomes for these children.
Methods:
We performed a systematic review searching MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar for articles published between January 1, 1980 and September 29, 2020 about the perioperative care of children undergoing emergency abdominal surgery. We also conducted secondary searching of references and citations, and we included international professional publications.
Results:
We identified and analysed 383 peer-reviewed articles and 18 grey literature publications. High-grade evidence pertaining to the perioperative care of this patient group is limited. Most of the evidence available relates to improving diagnostic accuracy using preoperative blood testing, imaging, and clinical decision tools. Processes associated with clinical outcomes include time lapse between time of presentation or initial assessment and surgery, and the use of particular analgesia and antibiotic protocols. Structural factors identified include hospital and surgeon caseload and the use of perioperative care pathways.
Conclusions:
This review summarises the structural and process measures associated with outcome in paediatric emergency abdominal surgery. Such measures provide a means of evaluating care and identifying areas of practice that require quality improvement, especially in children with appendicitis.
Clinical Trial Registration:
PROSPERO CRD42017055285.
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