Title
A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough?
Document Type
Article
Publication Date
4-1-2016
Identifier
DOI: 10.1016/j.jpedsurg.2015.10.046
Abstract
Background/purpose: Surgical wound classification (SWC) is widely utilized for surgical site infection (SSI) risk stratification and hospital comparisons. We previously demonstrated that nearly half of common pediatric operations are incorrectly classified in eleven hospitals. We aimed to improve multicenter, intraoperative SWC assignment through targeted quality improvement (QI) interventions.
Methods: A before-and-after study from 2011-2014 at eleven children's hospitals was conducted. The SWC recorded in the hospital's intraoperative record (hospital-based SWC) was compared to the SWC assigned by a surgeon reviewer utilizing a standardized algorithm. Study centers independently performed QI interventions. Agreement between the hospital-based and surgeon SWC was analyzed with Cohen's weighted kappa and chi square.
Results: Surgeons reviewed 2034 cases from 2011 (Period 1) and 1998 cases from 2013 (Period 2). Overall SWC agreement improved from 56% to 76% (p<0.01) and weighted kappa from 0.45 (95% CI 0.42-0.48) to 0.73 (95% CI 0.70-0.75). Median (range) improvement per institution was 23% (7-35%). A dose-response-like pattern was found between the number of interventions implemented and the amount of improvement in SWC agreement at each institution.
Conclusions: Intraoperative SWC assignment significantly improved after resource-intensive, multifaceted interventions. However, inaccurate wound classification still commonly occurred. SWC used in SSI risk-stratification models for hospital comparisons should be carefully evaluated.
Journal Title
Journal of pediatric surgery
Volume
51
Issue
4
First Page
639
Last Page
644
MeSH Keywords
Algorithms; Child; Decision Support Techniques; Hospitals, Pediatric; Humans; Intraoperative Care; Longitudinal Studies; Quality Improvement; Risk Assessment; Surgical Wound; Surgical Wound Infection; United States
Keywords
quality metric; risk stratification; surgical site infection; surgical wound class; wound classification.
Recommended Citation
Putnam, L. R., Levy, S. M., Blakely, M. L., Lally, K. P., Wyrick, D. L., Dassinger, M. S., Russell, R. T., Huang, E. Y., Vogel, A. M., Streck, C. J., Kawaguchi, A. L., Calkins, C. M., St Peter, S. D., Abbas, P. I., Lopez, M. E., Tsao, K., . A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough? Journal of pediatric surgery 51, 639-644 (2016).
