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

Raval, Mehul V.; Dillon, Peter W.; Bruny, Jennifer; Ko, Clifford Y.; Hall, Bruce L.; Moss, Richard L.; Oldham, Keith T.; Richards, Karen; Vinocur, Charles D.; Ziegler, Moritz M.

doi:10.1016/j.jpedsurg.2010.09.073

Cited by 176 publications

(99 citation statements)

References 9 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Perioperative events and complications were identified in Peds NSQIP using variables predetermined by NSQIP. 15,19 To clarify definitions, the accompanying data dictionary and Peds NSQIP surgical clinical reviewers were consulted to ensure uniform interpretation. The corresponding categories of perioperative events and complications were identified in KID using ICD-9 codes.…”

Section: Resultsmentioning

confidence: 99%

“…Algorithms in the published literature and the recommendations of the US Food and Drug Administration's MiniSentinel program for identifying health outcomes of interest from administrative and claims data were used (http:// www.mini-sentinel.org/methods/outcome_identification/ default.aspx). 3,5,6,11,13,15 The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, and 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, and 0%-0.8% in the literature) were low and similar between the 2 data sets. The rates of blood product transfusion (36% in KID and 64% in Peds NSQIP) varied between the 2 data sets.…”

Section: Resultsmentioning

confidence: 99%

“…Also, the sampling method dictates that the year is divided into 46 8-day collection cycles, and only the first number of cases that met the inclusion criteria are captured. 15 This method may not fully reflect the effects of a center's patient volume.…”

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

FOC

View full text Add to dashboard Cite

OBJECT Research conducted using large administrative data sets has increased in recent decades, but reports on the fidelity and reliability of such data have been mixed. The goal of this project was to compare data from a large, administrative claims data set with a quality improvement registry in order to ascertain similarities and differences in content. METHODS Data on children younger than 12 months with nonsyndromic craniosynostosis who underwent surgery in 2012 were queried in both the Kids’ Inpatient Database (KID) and the American College of Surgeons Pediatric National Surgical Quality Improvement Program (Peds NSQIP). Data from published clinical craniosynostosis surgery series are reported for comparison. RESULTS Among patients younger than 12 months of age, a total of 1765 admissions were identified in KID and 391 in Peds NSQIP in 2012. Only nonsyndromic patients were included. The mean length of stay was 3.2 days in KID and 4 days in Peds NSQIP. The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, 0%-0.8% in the literature) were low and similar between the 2 data sets. The reported rates of blood transfusion (36% in KID, 64% in Peds NSQIP, and 1.7%-100% in the literature) varied between the 2 data sets. CONCLUSIONS Both the KID and Peds NSQIP databases provide large samples of surgical patients, with more cases reported in KID. The rates of complications studied were similar between the 2 data sets, with the exception of blood transfusion events where the retrospective chart review process of Peds NSQIP captured almost double the rate reported in KID.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

FOC

View full text Add to dashboard Cite

show abstract

“…1,7 Particular challenges associated with assessing children' s surgery outcomes include the following: (1) markedly lower complication and mortality rates, (2) comorbid conditions that occur with less frequency but are more complex to group and categorize, and (3) markedly lower surgical volumes such that available sample sizes at single institutions can be an order of magnitude below those for adults. Consequently, the NSQIP-Pediatric was initiated by the ACS as a pilot program with 4 hospitals in 2008, 8,9 and subsequently opened for voluntary subscription by hospitals that treat children. 10 This program has incorporated a wide range of surgical specialties and pediatric-specific comorbidities, procedures, and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to claims databases that rely on billing or administrative codes with potentially inconsistent clinical meaning, [11][12][13] the NSQIPPediatric utilizes trained personnel to prospectively collect comprehensive clinical data from the medical record. After establishing feasibility, 8,9 the NSQIP-Pediatric rapidly expanded to include more than 40 hospitals. Data from 2010 yielded the first riskadjusted assessment of hospital performance in postoperative mortality and morbidity for children' s surgeries.…”

Section: Discussionmentioning

confidence: 99%

Risk-Adjusted Hospital Outcomes for Children’s Surgery

Saito¹,

Chen

Hall

et al. 2013

Pediatrics

Self Cite

View full text Add to dashboard Cite

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 procedure-specific 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.

show abstract