美国外科医师学会国家外科质量改进计划儿科：β阶段报告。
American College of Surgeons National Surgical Quality Improvement Program Pediatric: a beta phase report.
机构信息
Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
出版信息
J Pediatr Surg. 2013 Jan;48(1):74-80. doi: 10.1016/j.jpedsurg.2012.10.019.
PURPOSE
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.
CONCLUSION
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.
目的
美国外科医师学院（ACS）国家外科质量改进计划儿科（NSQIP-P）扩大到β阶段测试，共有 29 家机构参与。数据收集和分析旨在完善该计划，并为机构间比较开发风险调整模型。
方法
分析了β阶段 NSQIP-P 的第一个完整年度的数据。患者入组采用了针对儿科专业定制的 ACS-NSQIP 方法。使用分层逻辑回归方法和 8 个预测变量对所有儿科和新生儿手术以及儿科（不包括新生儿）腹部手术进行了初步的风险调整模型构建，用于所有病因发病率（除死亡外）和手术部位感染（SSI）。结果表示为优势比及其 95%置信区间。
结果
在 2010 年日历年期间，29 家机构共入组 37141 名患者。共输入了 1644 个 CPT 代码，其中 456 个占病例的 90%。450 个代码仅输入一次（占病例的 1.2%）。所有病例的总死亡率为 0.25%，总发病率为 7.9%，SSI 发生率为 1.8%。新生儿病例的死亡率为 2.39%，发病率为 18.7%，SSI 发生率为 3%。对于所有手术模型，风险调整发病率的机构优势比范围为 0.48-2.63，29 家医院中有 9 家为低异常值，9 家为高异常值，而风险调整 SSI 的机构优势比范围为 0.36-2.04，29 家医院中有 2 家为低异常值，7 家为高异常值。
结论
本报告代表了使用 NSQIP-P 数据对婴儿和儿童手术结果进行的首次风险调整的医院间比较。随着该计划全面实施，计划和分析的修改将提高该计划的影响力。这些结果表明，NSQIP-P 有可能成为确定新生儿和儿科人群风险调整结果的模型，目标是为儿童外科护理制定质量改进计划。
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