title: American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report.
abstract: OBJECTIVE
  The American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatric (NSQIP-P) expanded to beta phase testing with the enrollment of 29 institutions. Data collection and analysis were aimed at program refinement and development of risk-adjusted models for inter-institutional comparisons.
  
  
  METHODS
  Data from the first full year of beta-phase NSQIP-P were analyzed. Patient accrual used ACS-NSQIP methodology tailored to pediatric specialties. Preliminary risk adjusted modeling for all pediatric and neonatal operations and pediatric (excluding neonatal) abdominal operations was performed for all cause morbidity (other than death) and surgical site infections (SSI) using hierarchical logistic regression methodology and eight predictor variables. Results were expressed as odds ratios with 95% confidence intervals.
  
  
  RESULTS
  During calendar year 2010, 29 institutions enrolled 37,141 patients. 1644 total CPT codes were entered, of which 456 accounted for 90% of the cases. 450 codes were entered only once (1.2% of cases). For all cases, overall mortality was 0.25%, overall morbidity 7.9%, and the SSI rate 1.8%. For neonatal cases, mortality was 2.39%, morbidity 18.7%, and the SSI rate 3%. For the all operations model, risk-adjusted morbidity institutional odds ratios ranged 0.48-2.63, with 9/29 hospitals categorized as low outliers and 9/29 high outliers, while risk-adjusted SSI institutional odds ratios ranged 0.36-2.04, with 2/29 hospitals low outliers and 7/29 high outliers.
  
  
  CONCLUSIONS
  This report represents the first risk-adjusted hospital-level comparison of surgical outcomes in infants and children using NSQIP-P data. Programmatic and analytic modifications will improve the impact of this program as it moves into full implementation. These results indicate that NSQIP-P has the potential to serve as a model for determining risk-adjusted outcomes in the neonatal and pediatric population with the goal of developing quality improvement initiatives for the surgical care of children.
authors: Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA. jennifer.bruny@childrenscolorado.org
authors: Jennifer L
authors: JL
authors: Bruny
authors: Bruce L
authors: BL
authors: Hall
authors: Douglas C
authors: DC
authors: Barnhart
authors: Deborah F
authors: DF
authors: Billmire
authors: Mark S
authors: MS
authors: Dias
authors: Peter W
authors: PW
authors: Dillon
authors: Charles
authors: C
authors: Fisher
authors: Kurt F
authors: KF
authors: Heiss
authors: William L
authors: WL
authors: Hennrikus
authors: Clifford Y
authors: CY
authors: Ko
authors: Lawrence
authors: L
authors: Moss
authors: Keith T
authors: KT
authors: Oldham
authors: Karen E
authors: KE
authors: Richards
authors: Rahul
authors: R
authors: Shah
authors: Charles D
authors: CD
authors: Vinocur
authors: Moritz M
authors: MM
authors: Ziegler
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010372:Pediatrics / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D020379:Risk Adjustment; D013043:Specialties, Surgical / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States