APSA Papers
Pediatric American College of Surgeons National Surgical Quality Improvement Program: feasibility of a novel, prospective assessment of surgical outcomes

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Abstract

Purpose

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) provides validated assessment of surgical outcomes. This study reports initiation of an ACS NSQIP Pediatric at 4 children's hospitals.

Methods

From October 2008 to June 2009, 121 data variables were prospectively collected for 3315 patients, including 30-day outcomes and tailoring the ACS NSQIP methodology to children's surgical specialties.

Results

Three hundred seven postoperative complications/occurrences were detected in 231 patients representing 7.0% of the study population. Of the patients with complications, 175 (75.7%) had 1, 39 (16.9%) had 2, and 17 (7.4%) had 3 or more complications. There were 13 deaths (0.39%) and 14 intraoperative occurrences (0.42%) detected. The most common complications were infection, 105 (34%) (SSI, 54; sepsis, 31; pneumonia, 13; urinary tract infection, 7); airway/respiratory events, 27 (9%); wound disruption, 18 (6%); neurologic events, 8 (3%) (nerve injury, 4; stroke/vascular event, 2; hemorrhage, 2); deep vein thrombosis, 3 (<1%); renal failure, 3 (<1%); and cardiac events, 3 (<1%). Current sampling captures 17.5% of cases across institutions with unadjusted complication rates ranging from 6.8% to 10.2%. Completeness of data collection for all variables exceeded 95% with 98% interrater reliability and 87% of patients having full 30-day follow-up.

Conclusion

These data represent the first multiinstitutional prospective assessment of specialty-specific surgical outcomes in children. The ACS NSQIP Pediatric is poised for institutional expansion and future development of risk-adjusted models.

Section snippets

Methods

The specific variables and outcomes collected in the ACS NSQIP Pediatric have been previously described [5]. In brief, approximately 121 variables were prospectively collected: 6 demographic, 8 surgical profile, 46 clinical preoperative, 13 laboratory, 16 intraoperative, and 32 postoperative. In addition, variables of interest were collected for special populations such as neonates undergoing surgical procedures. Thirty-day outcomes of interest ranged from mortality to specific end points such

Results

From October 2008 to June 2009, data variables were prospectively collected for 3315 patients. These patients represented cases from 183 surgeons, 685 cities, and 31 states. The ACS NSQIP Pediatric sampled 16.8% of eligible procedures across the 4 institutions (volume weighted), while the average sampling rate across the 4 was 17.5% (unweighted) with samples ranging from 502 cases to 1056 cases. Variation in sampling volumes was primarily because of variation in program start dates and vacation

Discussion

This interim report demonstrates the successful implementation of the ACS NSQIP Pediatric phase 1 at 4 tertiary pediatric centers. Feasibility of the program implementation is shown through adoption of the standard ACS NSIQP systematic sampling of cases, collection of clinically relevant variables and outcomes as outlined before program initiation, and creation of a data abstraction technology platform. The data collection process has been validated through rigorous auditing of each

Acknowledgments

MVR participates in the American College of Surgeons Clinical Scholars in Residence Program. MVR is supported by the John Gray Research Fellowship and the Daniel F. and Ada L. Rice Foundation. The authors would like to thank the ACS NSQIP staff and the tremendous efforts toward high-quality, accurate data collection by the ACS NSQIP SCRs.

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1

ACS NSQIP Pediatric Steering Committee: American College of Surgeons, Chicago, Ill (Mira Shiloach, MS; Charles Fischer, BS); The Children's Hospital, Aurora, Colo (Debra Liebrecht, RN); Children's Hospital of Wisconsin, Milwaukee, Wis (Yvonne Anderson, RN, MS); Yale New Haven Children's Hospital, New Haven, Conn (Marilyn Hirsch, RN; Debbie Ferrigno, RN); A.I. DuPont Hospital for Children, Wilmington, Del (Michael Marchildon, MD; Christine Schuck, RN); Colorado Health Outcomes Program, Denver, Colo (Karl Hammermeister, MD; William Henderson, PhD; Elaine Morrato, DrPH, MPH); QC Metrix (Kathy Rowell, MS; Janet Steeger, RN).

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