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Assessing process measures and practice variability in pediatric esophageal button battery cases: A
Anoosha Moturu1, Vanessa Thompson2, Catherine Grant2
1American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL, USA; Stanford Healthcare, Stanford, CA, USA.
Insights
Esophageal button battery ingestion in children is a critical emergency. This study found that repeat imaging for referred patients and delayed postoperative esophagrams can prolong treatment times, highlighting areas for care improvement.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Surgical Quality Improvement
Background:
- Esophageal button battery (BB) ingestion is a rare but serious pediatric emergency.
- Timely intervention is crucial to prevent severe morbidity and mortality.
- The National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) offers data to assess care processes.
Purpose of the Study:
- To analyze esophageal BB process measure data from NSQIP-Ped.
- To identify variations in care delivery for pediatric esophageal BB ingestions.
- To pinpoint opportunities for enhancing patient care and outcomes.
Main Methods:
- Retrospective analysis of pediatric patients (0-17 years) with esophageal BB ingestion (Jan 2021-Dec 2023) using NSQIP-Ped data.
- Assessment of care timeliness, perioperative imaging, and intraoperative sterile acetic acid irrigation.
- Subgroup analysis of repeat imaging impact on intervention times.
Main Results:
- 86 patients from 28 institutions were analyzed.
- Median presentation-to-operation time was 98 minutes.
- Repeat imaging in referred patients significantly increased presentation-to-operation time (104 vs. 62 min, p=0.013).
- Sterile acetic acid irrigation was used in 70% of cases, with adequate volume in 87%.
Conclusions:
- Reducing repeat imaging for referred patients can expedite care.
- Optimizing postoperative esophagram timing is needed.
- Improving sterile acetic acid irrigation documentation and use can standardize care and reduce button battery ingestion morbidity.
Background:
Esophageal button battery (BB) is a rare, time-sensitive pediatric emergency with potential for severe morbidity and mortality. This study uses first available esophageal BB process measure data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) to identify areas of practice variability and identify opportunities for improving care.
Methods:
This retrospective study analyzed NSQIP-Ped pediatric patients (0-17 years) with esophageal BB ingestion from January 2021-December 2023. Process measures assessed care timeliness, perioperative imaging, and intraoperative 0.25 % sterile acetic acid irrigation. Descriptive statistics assessed cohort and hospital level variability. A subgroup analysis evaluated the impact of repeat imaging at the receiving institution on intervention times.
Results:
86 patients from 28 institutions were included. Median time from presentation to diagnosis was 31 min (interquartile range [IQR]: 23-53), diagnosis to operation 76 min (IQR: 53-87), presentation to operation 98 min (IQR: 76-119), and operation to postoperative esophagram 1.4 days (IQR: 0.8-2.8). Among referred patients, those who underwent repeat imaging had significantly longer presentation to operation times compared to those who did not (104 vs. 62 min, p = 0.013). Sterile acetic acid irrigation usage was documented in 70 % of cases, with 87 % of these cases receiving >50 mL of irrigation.
Conclusion:
The study highlights opportunities to reduce repeat imaging for patients referred to institutions, establish the optimal timing for postoperative esophagram, and improve documentation and utilization of sterile acetic acid irrigation. These efforts may expedite and standardize care to reduce morbidity associated with button battery ingestion.
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