title: Splenectomy in hereditary spherocytosis: Review of 1,657 patients and application of the pediatric quality indicators.
abstract: OBJECTIVE
  The objective of the present study is to profile the outcome and safety of pediatric patients undergoing splenectomy with hereditary spherocytosis (HS) using a nationwide sample and the Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDIs).
  
  
  METHODS
  A retrospective cross-sectional descriptive analysis of a non-overlapping combination of the National Inpatient Sample (NIS), and Kids' Inpatient Database (KID) databases (1988-2004) were performed. These combined databases contain information from nearly 93 million discharges in the United States. Children with an age at admission of <18 years of age and HS (ICD-9 diagnosis code of 282.0) who underwent total splenectomy (ICD-9 procedure code of 41.5) were identified. Variables of gender, race, co-existing diagnoses, hospital type, and charges adjusted to 2006 dollars, length of stay, inpatient mortality, and complications were collected. PDIs were identified for each patient by linking the data obtained from the NIS and KID databases with the PDIs using the AHRQ Quality Indicators Wizard.
  
  
  RESULTS
  Splenectomy for HS was associated with low morbidity and mortality. Accompanying cholecystectomy and/or appendectomy appeared to be safely performed at the same operation. Of the 13 PDIs identified by AHRQ as potentially avoidable adverse events, none were observed to occur in more than 1% of the patients.
  
  
  CONCLUSIONS
  Based on the results of this study, splenectomy in patients with HS appears safe and to result in a minimal number of potentially preventable complications as identified by the AHRQ PDIs. We have successfully demonstrated use of the indicators to aid in the analysis of a specific surgical procedure within a subset of the pediatric population.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0005, USA. fa@jhmi.edu
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Melissa
authors.initials: M
authors.lastname: Camp
authors.forename: Mark I
authors.initials: MI
authors.lastname: Rossberg
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Bathurst
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nabaweesi
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013103:Spherocytosis, Hereditary / Q000601:surgery*; D013156:Splenectomy