一份基准报告在平衡复杂阑尾炎患儿感染预防与抗菌药物管理方面的效用

Utility of a Benchmarking Report for Balancing Infection Prevention and Antimicrobial Stewardship in Children With Complicated Appendicitis.

作者信息

Cramm Shannon L, Graham Dionne A, Blakely Martin L, Cowles Robert A, Kunisaki Shaun M, Lipskar Aaron M, Russell Robert T, Santore Matthew T, DeFazio Jennifer R, Griggs Cornelia L, Aronowitz Danielle I, Allukian Myron, Campbell Brendan T, Chandler Nicole M, Collins Devon T, Commander Sarah J, Dukleska Katerina, Echols Justice C, Esparaz Joseph R, Feng Christina, Gerall Claire, Hanna David N, Keane Olivia A, McLean Sean E, Pace Elizabeth, Scholz Stefan, Sferra Shelby R, Tracy Elisabeth T, Williams Sacha, Zhang Lucy, He Katherine, Rangel Shawn J

机构信息

Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA.

出版信息

Ann Surg. 2025 Jan 1;281(1):170-175. doi: 10.1097/SLA.0000000000006246. Epub 2024 Feb 22.

DOI:10.1097/SLA.0000000000006246

PMID:38385252

Abstract

OBJECTIVE

To develop a severity-adjusted, hospital-level benchmarking comparative performance report for postoperative organ space infection (OSI) and antibiotic utilization in children with complicated appendicitis.

BACKGROUND

No benchmarking data exist to aid hospitals in identifying and prioritizing opportunities for infection prevention or antimicrobial stewardship in children with complicated appendicitis.

METHODS

This was a multicenter cohort study using National Surgical Quality Improvement Program-Pediatric data from 16 hospitals participating in a regional research consortium, augmented with antibiotic utilization data obtained through supplemental chart review. Children with complicated appendicitis who underwent appendectomy from July 1, 2015 to June 30, 2020 were included. Thirty-day postoperative OSI rates and cumulative antibiotic utilization were compared between hospitals using observed-to-expected (O/E) ratios after adjusting for disease severity using mixed-effect models. Hospitals were considered outliers if the 95% CI for O/E ratios did not include 1.0.

RESULTS

A total of 1790 patients were included. Overall, the OSI rate was 15.6% (hospital range: 2.6% to 39.4%) and median cumulative antibiotic utilization was 9.0 days (range: 3.0 to 13.0). Across hospitals, adjusted O/E ratios ranged 5.7-fold for OSI (0.49 to 2.80, P = 0.03) and 2.4-fold for antibiotic utilization (0.59 to 1.45, P < 0.01). Three (19%) hospitals were outliers for OSI (1 high and 2 low performers), and 8 (50%) were outliers for antibiotic utilization (5 high and 3 low utilizers). Ten (63%) hospitals were identified as outliers in one or both measures.

CONCLUSIONS

A comparative performance benchmarking report may help hospitals identify and prioritize quality improvement opportunities for infection prevention and antimicrobial stewardship, as well as identify exemplar performers for dissemination of best practices.

摘要

目的

制定一份针对复杂性阑尾炎患儿术后器官腔隙感染（OSI）及抗生素使用情况的、经病情严重程度调整的医院层面基准比较绩效报告。

背景

目前尚无基准数据可帮助医院识别并优先处理复杂性阑尾炎患儿感染预防或抗菌药物管理方面的机会。

方法

这是一项多中心队列研究，使用了来自16家参与区域研究联盟医院的国家外科质量改进计划 - 儿科数据，并通过补充病历审查获得抗生素使用数据。纳入2015年7月1日至2020年6月30日期间接受阑尾切除术的复杂性阑尾炎患儿。使用混合效应模型在调整疾病严重程度后，通过观察值与期望值（O/E）比率比较各医院之间的术后30天OSI率和累积抗生素使用情况。如果O/E比率的95%置信区间不包括1.0，则将医院视为异常值。

结果

共纳入1790例患者。总体而言，OSI率为15.6%（各医院范围：2.6%至39.4%），累积抗生素使用中位数为9.0天（范围：3.0至13.0）。在各医院中，调整后的OSI的O/E比率范围为5.7倍（0.49至2.80，P = 0.03），抗生素使用的O/E比率范围为2.4倍（0.59至1.45，P < 0.01）。3家医院（19%）为OSI异常值（1家表现高和2家表现低），8家医院（50%）为抗生素使用异常值（5家高使用者和

3家低使用者）。10家医院（63%）在一项或两项指标中被确定为异常值。