title: A comparison of two quality measurement tools in pediatric surgery--the American College of Surgeons National Surgical Quality Improvement Program-Pediatric versus the Agency for Healthcare Research and Quality Pediatric Quality Indicators.
abstract: OBJECTIVE
  Identifying quality in pediatric surgery can be difficult given the low frequency of postoperative complications. We compared postoperative events following pediatric surgical procedures at a single institution identified by ACS-NSQIP Pediatric (ACS NSQIP-P) methodology and AHRQ Pediatric Quality Indicators (AHRQ PDIs), an administrative tool.
  
  
  METHODS
  AHRQ PDI algorithms were run on inpatient hospital discharge abstracts for 1257 children in the 2010 to 2013 ACS NSQIP-P at our institution. Four events-pulmonary complications, postoperative sepsis, wound dehiscence and bleeding-were matched between ACS NSQIP-P and AHRQ PDI.
  
  
  RESULTS
  Events were identified by ACS NSQIP-P in 7.9% of children and by AHRQ PDI in 8.0%. The four matched events were identified in 5.5% and 3.7%, respectively. Specificities of AHRQ PDI ranged from 97% to 100% and sensitivities from 0 to 2%. The largest discrepancy was in bleeding, where AHRQ PDI captured 1 of the 54 events identified by ACS NSQIP-P. None of the 41 pulmonary, sepsis, and wound dehiscence events identified by AHRQ PDI were clinically relevant according to ACS NSQIP-P.
  
  
  CONCLUSIONS
  Adverse events following pediatric surgery are infrequent; thus, additional measures of quality to supplement postoperative adverse events are needed. AHRQ PDIs are inadequate for assessing quality in pediatric surgery.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Polites
authors.affiliation: Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagie
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wiskerchen
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Moir
authors.affiliation: Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address: ishitani.michael@mayo.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013043:Specialties, Surgical / Q000592:standards*; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
keywords: American College of Surgeons National Surgical Quality Improvement Program–Pediatric; Pediatric Quality Indicators; Pediatric surgery; Postoperative complications; Quality