Pediatric American College of Surgeons National Surgical Quality Improvement Program: feasibility of a novel, prospective assessment of surgical outcomes.
OBJECTIVE
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) provides validated assessment of surgical outcomes. This study reports initiation of an ACS NSQIP Pediatric at 4 children's hospitals.


METHODS
From October 2008 to June 2009, 121 data variables were prospectively collected for 3315 patients, including 30-day outcomes and tailoring the ACS NSQIP methodology to children's surgical specialties.


RESULTS
Three hundred seven postoperative complications/occurrences were detected in 231 patients representing 7.0% of the study population. Of the patients with complications, 175 (75.7%) had 1, 39 (16.9%) had 2, and 17 (7.4%) had 3 or more complications. There were 13 deaths (0.39%) and 14 intraoperative occurrences (0.42%) detected. The most common complications were infection, 105 (34%) (SSI, 54; sepsis, 31; pneumonia, 13; urinary tract infection, 7); airway/respiratory events, 27 (9%); wound disruption, 18 (6%); neurologic events, 8 (3%) (nerve injury, 4; stroke/vascular event, 2; hemorrhage, 2); deep vein thrombosis, 3 (<1%); renal failure, 3 (<1%); and cardiac events, 3 (<1%). Current sampling captures 17.5% of cases across institutions with unadjusted complication rates ranging from 6.8% to 10.2%. Completeness of data collection for all variables exceeded 95% with 98% interrater reliability and 87% of patients having full 30-day follow-up.


CONCLUSIONS
These data represent the first multiinstitutional prospective assessment of specialty-specific surgical outcomes in children. The ACS NSQIP Pediatric is poised for institutional expansion and future development of risk-adjusted models.
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611-3211, USA. m-raval@md.northwestern.edu
Mehul V
MV
Raval
Peter W
PW
Dillon
Jennifer L
JL
Bruny
Clifford Y
CY
Ko
Bruce L
BL
Hall
R Lawrence
RL
Moss
Keith T
KT
Oldham
Karen E
KE
Richards
Charles D
CD
Vinocur
Moritz M
MM
Ziegler
D000328:Adult; D019985:Benchmarking / Q000379:methods; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006776:Hospitals, Pediatric; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards; D058996:Quality Improvement / Q000592:standards*; D012955:Societies, Medical / Q000592:standards*; D013043:Specialties, Surgical / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States