A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough?

Pediatric Surgical Research Collaborative

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)639-644
Number of pages6
JournalJournal of pediatric surgery
Volume51
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Quality Improvement
Pediatrics
Surgical Wound Infection
Surgical Wound
Hospital Records

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough? / Pediatric Surgical Research Collaborative.

In: Journal of pediatric surgery, Vol. 51, No. 4, 01.04.2016, p. 639-644.

Research output: Contribution to journalArticle

@article{972ed298685343a2a4b3d66a5f703f95,
title = "A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough?",
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.",
author = "{Pediatric Surgical Research Collaborative} and Putnam, {Luke R.} and Levy, {Shauna M.} and Blakely, {Martin L.} and Lally, {Kevin P.} and Wyrick, {Deidre L.} and Dassinger, {Melvin S.} and Russell, {Robert T.} and Huang, {Eunice Y.} and Eunice Huang and Streck, {Christian J.} and Kawaguchi, {Akemi L.} and Calkins, {Casey M.} and {St Peter}, {Shawn D.} and Abbas, {Paulette I.} and Lopez, {Monica E.} and Kuojen Tsao",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.jpedsurg.2015.10.046",
language = "English (US)",
volume = "51",
pages = "639--644",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - A multicenter, pediatric quality improvement initiative improves surgical wound class assignment, but is it enough?

AU - Pediatric Surgical Research Collaborative

AU - Putnam, Luke R.

AU - Levy, Shauna M.

AU - Blakely, Martin L.

AU - Lally, Kevin P.

AU - Wyrick, Deidre L.

AU - Dassinger, Melvin S.

AU - Russell, Robert T.

AU - Huang, Eunice Y.

AU - Huang, Eunice

AU - Streck, Christian J.

AU - Kawaguchi, Akemi L.

AU - Calkins, Casey M.

AU - St Peter, Shawn D.

AU - Abbas, Paulette I.

AU - Lopez, Monica E.

AU - Tsao, Kuojen

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84963944115&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84963944115&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2015.10.046

DO - 10.1016/j.jpedsurg.2015.10.046

M3 - Article

VL - 51

SP - 639

EP - 644

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 4

ER -