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Quality program has potential to measure children’s surgical outcomes

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A novel quality improvement program could potentially identify outcomes of children's surgical care, determine the reasons behind complications and assist hospitals in implementing improvement efforts, according to a study published in the January issue of the Journal of the American College of Surgeons.

The study investigated the phase 1 pilot of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP Peds) — a partnership of the American College of Surgeons (ACS) and the American Pediatric Surgical Association.

ACS NSQIP Peds was based on the successes of the ACS NSQIP program, which has reportedly been shown to help hospitals prevent 250 to 500 complications and save 12 to 36 lives per hospital per year. The results of the study show the principles of ACS NSQIP can be translated to pediatric cases to help hospitals measure children’s outcomes. This data could then be used to prevent complications, save lives and reduce costs.

“An essential element”

In the study, outcomes for 7, 287 patients who underwent a surgical procedure between Oct. 2008 and Dec. 2009 were collected from four participating hospitals. The investigators collected data for general/thoracic surgery, otolaryngology, orthopedic surgery, urology, neurosurgery and plastic surgery. The reported overall mortality rate was 0.3%, with 3.9% of patients experiencing a postoperative complication. Infection was the most common complication, and rates varied by specialty and procedure.

Opportunities

According to the study authors, variability in the rate of complications indicates there are opportunities to identify what rates are above and below the hospital’s expected rate. Hospitals with higher than expected rates of complication can learn from centers with low rates in order to improve their quality of care.

“As health reform components are implemented over the next several years, we will see a greater focus on measuring patient outcomes and tying reimbursement to quality of care,” study author Clifford Y. Ko, MD, FACS, MS, MSHS, stated in an ACS press release. “Having robust clinical data in a nationally benchmarked, continuously updated database is an essential element to quality improvement. We now know the tools that have prevented complications and saved lives of adults can also be used for children.”

Further developments in the program will focus on risk-adjusting data to account for the health of the patient prior to the operation, as well as targeting specific procedures so hospitals can focus quality improvement efforts on procedures with higher rates of complications. The program is now in phase 2 of development at 29 hospitals around the country.

Reference:

• Rayal MV, et al. American College of Surgeons National Surgical Quality Improvement Program-Pediatric: a phase 1 report. J Am Coll Surgeons. 2011; 1-11. doi:10.1016/j.jamcollsurg.2010.08.013.

Disclosure: The authors have no relevant financial disclosures.

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