Wound classification in pediatric surgical procedures: Measured and found wanting.
PURPOSE: Surgical wound classification has emerged as a measure of surgical quality of care, but scant data exist in the era of minimally invasive procedures, especially in children. The aim of this study is to examine the surgical site infection (SSI) rate by wound classification during common pediatric surgical procedures.
METHODS: A retrospective analysis of the 2013 Pediatric-National Surgical Quality Improvement Program (Peds-NSQIP) dataset was conducted. Patients undergoing pyloromyotomy, cholecystectomy, ostomy reversal, and appendectomy were included. Wound classification, SSI rate, reoperation, and readmission were analyzed.
RESULTS: A total of 10,424 records were included. Pyloromyotomy, a clean case, had a 0.7% SSI rate, while ostomy reversal, a clean contaminated case, had an SSI in 6.9% of cases. Appendectomy for nonperforated acute appendicitis and laparoscopic cholecystectomy for cholecystitis, both contaminated cases, had SSI rates of 2.1% and40% for dirty cases. Reoperations and readmission rates ranged from
CONCLUSION: Current wound classifications systems do not reflect surgical risk in children and remain questionable tools for benchmarking surgical care in children. Role of readmissions and reoperations as quality of care indices needs further investigation.
Journal of pediatric surgery
Adolescent; Child; Child; Preschool; Databases; Factual; Humans; Infant; Infant; Newborn; Patient Readmission; Quality Improvement; Reoperation; Retrospective Studies; Surgical Wound Infection; United States; Wounds and Injuries
Pediatric Surgery; Wound Classification; Surgical Site Infection; Benchmarking
Oyetunji TA, Gonzalez DO, Gonzalez KW, Nwomeh BC, St Peter SD. Wound classification in pediatric surgical procedures: Measured and found wanting. J Pediatr Surg. 2016;51(6):1014-1016. doi:10.1016/j.jpedsurg.2016.02.070