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Multicenter Pediatric Surgery Quality Collaborative (PSQC) NSQIP pilot study: Pediatric colorectal surgery bundle

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Summary

A pilot study of a colon bundle checklist in pediatric colorectal surgery showed improved compliance over time. The checklist enhanced adherence to key surgical practices, demonstrating a realistic adoption rate for multicenter initiatives.

Keywords:
Bundle complianceBundle implementationColon bundleNSQIP-PPediatric colorectal surgeryPediatric surgery

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Area of Science:

  • Pediatric Surgery
  • Surgical Quality Improvement
  • Colorectal Surgery

Background:

  • The Pediatric Surgery Quality Collaborative (PSQC) initiated a pilot study in 2023.
  • The study utilized the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) platform.
  • A 7-item perioperative colon bundle checklist was implemented to enhance surgical care.

Purpose of the Study:

  • To analyze bundle compliance in a multicenter pediatric colorectal surgery initiative.
  • To identify specific compliance rates for each checklist item.
  • To assess the effectiveness of the colon bundle checklist in improving surgical outcomes.

Main Methods:

  • A 7-item perioperative colon bundle checklist was implemented across multiple centers.
  • Custom variables were created on the NSQIP-P platform to track checklist compliance.
  • Compliance data for pediatric colorectal cases (January 2023-September 2024) were analyzed, comparing implementation and control groups over time.

Main Results:

  • 361 cases were analyzed; implementation cases showed significantly better compliance than controls in most areas.
  • Highest compliance was observed for preoperative antibiotic administration (90%), lowest for intraoperative anastomotic leak testing (62%).
  • Mean bundle compliance score increased significantly over time in implementation cases (4.07 to 5.14, p=0.010), with notable improvements in specific practices.

Conclusions:

  • This study represents the largest multicenter initiative assessing a colon bundle checklist for pediatric colorectal surgery using NSQIP-Pediatric data.
  • Significant, though imperfect, compliance improvement over 21 months indicates a realistic adoption rate for multicenter quality initiatives.
  • The findings support the utility of the colon bundle checklist in enhancing surgical quality and adherence to best practices in pediatric colorectal surgery.