American college of surgeons national surgical quality improvement program pediatric: A beta phase report

Jennifer L. Bruny, Bruce L. Hall, Douglas C. Barnhart, Deborah F. Billmire, Mark S. Dias, Peter W. Dillon, Charles Fisher, Kurt F. Heiss, William L. Hennrikus, Clifford Y. Ko, Lawrence Moss, Keith T. Oldham, Karen E. Richards, Rahul Shah, Charles D. Vinocur, Moritz M. Ziegler

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Purpose: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons. Methods: Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals. Results: During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers. Conclusion: This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
JournalJournal of pediatric surgery
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2013

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Quality Improvement
Pediatrics
Surgical Wound Infection
Morbidity
Odds Ratio
Current Procedural Terminology
Surgeons
Infant Mortality
Child Care
Logistic Models
Confidence Intervals
Mortality
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Bruny, Jennifer L. ; Hall, Bruce L. ; Barnhart, Douglas C. ; Billmire, Deborah F. ; Dias, Mark S. ; Dillon, Peter W. ; Fisher, Charles ; Heiss, Kurt F. ; Hennrikus, William L. ; Ko, Clifford Y. ; Moss, Lawrence ; Oldham, Keith T. ; Richards, Karen E. ; Shah, Rahul ; Vinocur, Charles D. ; Ziegler, Moritz M. / American college of surgeons national surgical quality improvement program pediatric : A beta phase report. In: Journal of pediatric surgery. 2013 ; Vol. 48, No. 1. pp. 74-80.
@article{2d56f1bea9fb49288db097717f52caa0,
title = "American college of surgeons national surgical quality improvement program pediatric: A beta phase report",
abstract = "Purpose: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons. Methods: Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95{\%} confidence intervals. Results: During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90{\%} of the cases. 450 codes were entered only once (1.2{\%} of cases). For all cases, overall mortality was 0.25{\%}, overall morbidity 7.9{\%}, and the SSI rate 1.8{\%}. For neonatal cases, mortality was 2.39{\%}, morbidity 18.7{\%}, and the SSI rate 3{\%}. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers. Conclusion: This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.",
author = "Bruny, {Jennifer L.} and Hall, {Bruce L.} and Barnhart, {Douglas C.} and Billmire, {Deborah F.} and Dias, {Mark S.} and Dillon, {Peter W.} and Charles Fisher and Heiss, {Kurt F.} and Hennrikus, {William L.} and Ko, {Clifford Y.} and Lawrence Moss and Oldham, {Keith T.} and Richards, {Karen E.} and Rahul Shah and Vinocur, {Charles D.} and Ziegler, {Moritz M.}",
year = "2013",
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doi = "10.1016/j.jpedsurg.2012.10.019",
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Bruny, JL, Hall, BL, Barnhart, DC, Billmire, DF, Dias, MS, Dillon, PW, Fisher, C, Heiss, KF, Hennrikus, WL, Ko, CY, Moss, L, Oldham, KT, Richards, KE, Shah, R, Vinocur, CD & Ziegler, MM 2013, 'American college of surgeons national surgical quality improvement program pediatric: A beta phase report', Journal of pediatric surgery, vol. 48, no. 1, pp. 74-80. https://doi.org/10.1016/j.jpedsurg.2012.10.019

American college of surgeons national surgical quality improvement program pediatric : A beta phase report. / Bruny, Jennifer L.; Hall, Bruce L.; Barnhart, Douglas C.; Billmire, Deborah F.; Dias, Mark S.; Dillon, Peter W.; Fisher, Charles; Heiss, Kurt F.; Hennrikus, William L.; Ko, Clifford Y.; Moss, Lawrence; Oldham, Keith T.; Richards, Karen E.; Shah, Rahul; Vinocur, Charles D.; Ziegler, Moritz M.

In: Journal of pediatric surgery, Vol. 48, No. 1, 01.01.2013, p. 74-80.

Research output: Contribution to journalArticle

TY - JOUR

T1 - American college of surgeons national surgical quality improvement program pediatric

T2 - A beta phase report

AU - Bruny, Jennifer L.

AU - Hall, Bruce L.

AU - Barnhart, Douglas C.

AU - Billmire, Deborah F.

AU - Dias, Mark S.

AU - Dillon, Peter W.

AU - Fisher, Charles

AU - Heiss, Kurt F.

AU - Hennrikus, William L.

AU - Ko, Clifford Y.

AU - Moss, Lawrence

AU - Oldham, Keith T.

AU - Richards, Karen E.

AU - Shah, Rahul

AU - Vinocur, Charles D.

AU - Ziegler, Moritz M.

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N2 - Purpose: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons. Methods: Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals. Results: During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers. Conclusion: This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.

AB - Purpose: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons. Methods: Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals. Results: During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers. Conclusion: This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.

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