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Are Kids More Than Just Little Adults? A Comparison of Surgical Outcomes
Jessica Liu McMullin1, Q Lina Hu2, Ryan P Merkow3
1American College of Surgeons, Chicago, Illinois; Department of Surgery, Emory University, Atlanta, Georgia.
Insights
Children experience higher surgical site infections and readmission rates for appendectomies compared to adults. Quality improvement strategies for adults should be adapted for pediatric surgical care.
Area of Science:
- Surgical outcomes research
- Pediatric surgery
- Comparative effectiveness research
Background:
- National registries like NSQIP and NSQIP-Pediatric provide data on surgical complication rates.
- Direct comparisons of postoperative outcomes between pediatric and adult surgical patients are lacking.
Purpose of the Study:
- To compare postoperative outcomes between children and adults undergoing common surgical procedures.
Main Methods:
- Utilized data from 2013-2017 for laparoscopic appendectomy, cholecystectomy, thyroidectomy, and colectomy.
- Employed propensity score matching on multiple patient and procedure variables.
- Analyzed outcomes including surgical site infection (SSI), readmission, mortality/serious morbidity, and length of stay.
Main Results:
- Matched 79,866 patients across 812 hospitals.
- Children had higher SSI rates for appendectomy and cholecystectomy compared to adults.
- Children experienced higher readmission rates for appendectomy and longer hospital stays for all procedures, while adults had higher 30-day mortality/serious morbidity.
Conclusions:
- Pediatric and adult surgical patients exhibit distinct complication and outcome profiles.
- Adult quality improvement initiatives, such as SSI prevention and enhanced recovery protocols, should be extended to pediatric surgical care.
Introduction:
While complication rates have been well described using the National Surgical Quality Improvement Program (NSQIP) and National Surgical Quality Improvement Program-Pediatric registries, there have been no direct comparisons of outcomes between adults and children. Our objective was to describe differences in postoperative outcomes between children and adults undergoing common surgical procedures.
Methods:
Using data from 2013 to 2017, we identified patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, thyroidectomy, and colectomy. Propensity score matching on gender, race, American Society of Anesthesiologists class, surgical indication, and procedure type was performed. Outcomes included surgical site infection (SSI), readmission rates, mortality/serious morbidity, and hospital length of stay and were analyzed using χ2 and student's t-test with statistical significance defined as P < 0.05.
Results:
We matched 79,866 patients from 812 hospitals. Compared to adults, children had higher rates of SSI following appendectomy (4.12% versus 1.40%, P < 0.01) and cholecystectomy (0.96% versus 0.66%, P = 0.04), readmission following appendectomy (4.26% versus 2.47%, P < 0.01), and longer length of stay in all procedures. In adults, 30-day mortality/serious morbidity was higher for all procedures.
Conclusions:
Compared to adults, children demonstrate unique surgical complication and outcome profiles. Quality improvement efforts such as SSI prevention bundles and enhanced recovery protocols used in adults should be expanded to children.
