Risk management in pediatric surgery.
OBJECTIVE
To present the experience documented over 1 year of analysis and quality control on surgical complications and organizational accidents.


METHODS
All children admitted during the study period at our Institution were included in the analysis, which consisted of four phases: (1) definition and standardization of perioperative diagnostic and therapeutic tracks; (2) staff education; (3) documentation and data implementation, and (4) "Morbidity and Mortality" audit.


RESULTS
Over a 1-year study period, 3,116 children were admitted to our Institution: 2,222 out of 3,116 (71.3%) children underwent a surgical procedure. A total number of 184 complications were recorded in 149 patients. One hundred and seventy-one (92.9%) complications occurred following a surgical procedure. Fifty-six out of 149 complicated patients (37.6%) required a re-operation. Thirty-five out of 184 (19%) complications were classified as organizational. Infection represented the most common complication. All cases of anastomotic dehiscence and perforation, bowel obstruction, and stoma malfunction required reintervention. None of the postoperative bleedings required a second surgical procedure.


CONCLUSIONS
Although a proper statistical comparison with literature complication rates is not feasible, our experience confirms the importance of quality-control audit in health care systems. Prolonged observation, long-term follow up, and comparison with previous results will represent our future goal.
Mattioli
Girolamo
G
Pediatric Surgery Department, G. Gaslini Children's Hospital, Largo G. Gaslini, 5, 16147, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Avanzini
Stefano
S
Pini-Prato
Alessio
A
Buffa
Piero
P
Guida
Edoardo
E
Rapuzzi
Giovanni
G
Torre
Michele
M
Rossi
Valentina
V
Montobbio
Giovanni
G
Rosati
Ubaldo
U
Jasonni
Vincenzo
V
D002648:Child; D006801:Humans; D019300:Medical Errors; D011786:Quality Control; D011787:Quality of Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*