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Utility of a Benchmarking Report for Balancing Infection Prevention and Antimicrobial Stewardship in Children With
Shannon L Cramm1, Dionne A Graham2, Martin L Blakely3
1Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Benchmarking reports reveal significant variation in pediatric complicated appendicitis care. This study highlights opportunities for hospitals to improve infection prevention and antibiotic stewardship by identifying best practices.
Area of Science:
- Pediatric surgery
- Infectious disease
- Healthcare quality improvement
Background:
- Limited benchmarking data exists for pediatric complicated appendicitis care.
- Hospitals need tools to identify and prioritize infection prevention and antimicrobial stewardship efforts.
Purpose of the Study:
- To develop a severity-adjusted, hospital-level benchmarking report for postoperative organ space infection (OSI) and antibiotic use in children with complicated appendicitis.
- To compare performance across hospitals and identify outliers.
Main Methods:
- Multicenter cohort study using National Surgical Quality Improvement Program-Pediatric data (16 hospitals).
- Included children with complicated appendicitis undergoing appendectomy (July 2015-June 2020).
- Compared 30-day OSI rates and antibiotic use using observed-to-expected (O/E) ratios, adjusted for severity.
Main Results:
- 1790 patients included; overall OSI rate was 15.6% (range 2.6%-39.4%).
- Median antibiotic use was 9.0 days (range 3.0-13.0 days).
- Significant hospital variation in adjusted O/E ratios for OSI (5.7-fold) and antibiotic use (2.4-fold); 63% of hospitals were outliers in at least one measure.
Conclusions:
- A comparative performance benchmarking report can guide hospitals in quality improvement for infection prevention and antimicrobial stewardship.
- Identifies high-performing hospitals for best practice dissemination.
- Facilitates targeted interventions to reduce OSI and optimize antibiotic utilization.
Objective:
To develop a severity-adjusted, hospital-level benchmarking comparative performance report for postoperative organ space infection (OSI) and antibiotic utilization in children with complicated appendicitis.
Background:
No benchmarking data exist to aid hospitals in identifying and prioritizing opportunities for infection prevention or antimicrobial stewardship in children with complicated appendicitis.
Methods:
This was a multicenter cohort study using National Surgical Quality Improvement Program-Pediatric data from 16 hospitals participating in a regional research consortium, augmented with antibiotic utilization data obtained through supplemental chart review. Children with complicated appendicitis who underwent appendectomy from July 1, 2015 to June 30, 2020 were included. Thirty-day postoperative OSI rates and cumulative antibiotic utilization were compared between hospitals using observed-to-expected (O/E) ratios after adjusting for disease severity using mixed-effect models. Hospitals were considered outliers if the 95% CI for O/E ratios did not include 1.0.
Results:
A total of 1790 patients were included. Overall, the OSI rate was 15.6% (hospital range: 2.6% to 39.4%) and median cumulative antibiotic utilization was 9.0 days (range: 3.0 to 13.0). Across hospitals, adjusted O/E ratios ranged 5.7-fold for OSI (0.49 to 2.80, P = 0.03) and 2.4-fold for antibiotic utilization (0.59 to 1.45, P < 0.01). Three (19%) hospitals were outliers for OSI (1 high and 2 low performers), and 8 (50%) were outliers for antibiotic utilization (5 high and 3 low utilizers). Ten (63%) hospitals were identified as outliers in one or both measures.
Conclusions:
A comparative performance benchmarking report may help hospitals identify and prioritize quality improvement opportunities for infection prevention and antimicrobial stewardship, as well as identify exemplar performers for dissemination of best practices.
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