title: Does the American College of Surgeons National Surgical Quality Improvement Program pediatric provide actionable quality improvement data for surgical neonates?
abstract: OBJECTIVE
  The purpose of this project was to examine the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACSNSQIP-P) Participant Use File (PUF) to compare risk-adjusted outcomes of neonates versus other pediatric surgical patients.
  
  
  METHODS
  In the ACS-NSQIP-P 2012-2013 PUF, patients were classified as preterm neonate, term neonate, or nonneonate at the time of surgery. The primary outcomes were 30-day mortality and composite morbidity. Patient characteristics significantly associated with the primary outcomes were used to build a multivariate logistic regression model.
  
  
  RESULTS
  The overall 30-day mortality rate for preterm neonates, term neonate, and nonneonates was 4.9%, 2.0%, 0.1%, respectively (p<0.0001). The overall 30-day morbidity rate for preterm neonates, term neonates, and nonneonates was 27.0%, 17.4%, 6.4%, respectively (p<0.0001). After adjustment for preoperative and operative risk factors, both preterm (adjusted odds ratio, 95% CI: 2.0, 1.4-3.0) and term neonates (aOR, 95% CI: 1.9, 1.2-3.1) had a significantly increased odds of 30-day mortality compared to nonneonates.
  
  
  CONCLUSIONS
  Surgical neonates are a cohort who are particularity susceptible to postoperative morbidity and mortality after adjusting for preoperative and operative risk factors. Collaborative efforts focusing on surgical neonates are needed to understand the unique characteristics of this cohort and identify the areas where the morbidity and mortality can be improved.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite #3800, Salt Lake City, UT 84113-1103, USA. Electronic address: brian.bucher@imail2.org.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bucher
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University School of Medicine, 7100 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Duggan
authors.affiliation: Division of Neonatology, Department of Pediatrics, Vanderbilt University School of Medicine, 11111 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Grubb
authors.affiliation: Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University School of Medicine, 2301 Vanderbilt University Hospital, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.affiliation: Department of Pediatric Surgery, UT Health Medical School and Children's Memorial Hermann Hospital, 6431 Fannin Street, Suite 5.258, Houston, TX 77030, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University School of Medicine, 7100 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000592:standards; D014481:United States / Q000453:epidemiology
keywords: NSQIP; Neonatal surgery; Outcomes research; Quality improvement