TY - JOUR
T1 - Risk-adjusted hospital outcomes for children's surgery
AU - Saito, Jacqueline M.
AU - Chen, Li Ern
AU - Hall, Bruce L.
AU - Kraemer, Kari
AU - Barnhart, Douglas C.
AU - Byrd, Claudia
AU - Cohen, Mark E.
AU - Fei, Chunyuan
AU - Heiss, Kurt F.
AU - Huffman, Kristopher
AU - Ko, Clifford Y.
AU - Latus, Melissa
AU - Meara, John G.
AU - Oldham, Keith T.
AU - Raval, Mehul V.
AU - Richards, Karen E.
AU - Shah, Rahul K.
AU - Sutton, Laura C.
AU - Vinocur, Charles D.
AU - Lawrence Moss, R.
PY - 2013/9
Y1 - 2013/9
N2 - BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. METHODS: Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedurespecific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. RESULTS: In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. CONCLUSIONS: The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in actionable data.
AB - BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. METHODS: Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedurespecific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. RESULTS: In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. CONCLUSIONS: The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in actionable data.
KW - Benchmark
KW - Outcome assessment
KW - Pediatric
KW - Risk-adjustment
KW - Surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=84884574850&partnerID=8YFLogxK
U2 - 10.1542/peds.2013-0867
DO - 10.1542/peds.2013-0867
M3 - Article
C2 - 23918898
AN - SCOPUS:84884574850
SN - 0031-4005
VL - 132
SP - e677-e688
JO - Pediatrics
JF - Pediatrics
IS - 3
ER -