Accuracy of American College of Surgeons National Surgical Quality Improvement Program Pediatric for laparoscopic appendectomy at a single institution

Sharp, Nicole E.; Knott, E. Marty; Iqbal, Corey W.; Thomas, Priscilla; Peter, Shawn D. St.

doi:10.1016/j.jss.2013.05.066

Cited by 30 publications

(5 citation statements)

References 10 publications

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“…Previous studies have demonstrated consistency between variables collected in NSQIP and NSQIP-P relative to medical record review. [12][13][14] The ACS trains Surgical Clinical Reviewers (SCRs) at each institution and completes inter-rater reliability (IRR) audits on collected data. Overall IRR disagreement rates are approximately 2% (confirmed in alpha phase testing).…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Sherrod

McClugage

Mortellaro

et al. 2019

Journal of Pediatric Surgery

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Purpose: To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery.Methods: 153,220 inpatient pediatric surgical patients were selected from the 2012-2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan-Meier survival analysis.Results: 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred pre-discharge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p=0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p<0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOS were longer for patients with VTE (p<0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic=0.83).Conclusions: Pediatric post-surgical patients have unique risk factors for developing VTE.

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Section: Study Design and Data Sourcementioning

confidence: 99%

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Sherrod

McClugage

Mortellaro

et al. 2019

Journal of Pediatric Surgery

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“…Unplanned reoperation rate could be a useful quality indicator in surgery, and even more in pediatric surgery. It is a broadly applicable outcome measure because unplanned reoperations are not specific, meaning they can occur after any surgical procedure [ 9 , 10 ]. Unplanned reoperations are also reliable because they are only performed when necessary and their incidence is easily tracked using administrative registries [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

2022

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Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

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“…Comparing data between different institutions is difficult because of the age of the population, the disease's complexity and severity, and the follow-up period for each index surgery varies between hospitals. [ 3 20 ] Therefore, it is difficult to compare surgical quality between hospitals. For example, spontaneous ICH, vascular disease (AVM/aneurysm), or brain tumor with a lesion at different locations in the skull base or neurovascular involvement increases the complexity of the disease.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement

et al. 2021

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The unplanned return to the operating room rate is a quality metric for assessing hospital performance. This study aimed to evaluate the cause, incidence, and time interval of unplanned returns in index neurosurgical procedures within 30 days of the initial surgery as an internal audit. We retrospectively analyzed neurosurgical procedures between January 2015, and December 2019, in a single regional hospital. The definition of an unplanned return to the operating room was a patient who underwent two operations within 30 days when the second procedure was not planned, staged, or related to the natural course of the disease. A total of 4365 patients were identified in our analysis, of which 93 (2%) had an unplanned return to the operating room within 30 days of their initial surgery during admission. The most common reason for an unplanned return to the operating room for a cranial procedure was hemorrhage, followed by hydrocephalus and subdural effusion, which accounted for 49.5%(46/93), 12%(11/93), and 5.4%(5/93) of cases, respectively. In spinal procedures, the most common cause of return was a residual disc, followed by surgical site infection, which accounted for 5.4%(5/93) and 4.3%(4/93) of cases, respectively. The overall median time interval for unplanned returns to the operating room was 3 days (interquartile range, 1–9). Lowering the rate of postoperative hemorrhage in cranial surgery and postoperative residual disc in spine surgery was crucial as an internal audit in a 5-year single institute follow-up. However, the unplanned reoperation rate is less helpful in benchmarking because of the heterogeneity of patients between hospitals.

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Accuracy of American College of Surgeons National Surgical Quality Improvement Program Pediatric for laparoscopic appendectomy at a single institution

Cited by 30 publications

References 10 publications

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement

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