A. M. Stey1, B. L. Hall2,6, M. Cohen2, C. Y. Ko2,5, S. Rangel4, K. Kraemer2, R. Moss3 1Mount Sinai,New York, NY, USA 2American College Of Surgeons,Chicago, IL, USA 3Nationwide Childrens Hospital,Columbus, OHIO, USA 4Boston Children’s Hospital,Boston, MA, USA 5University Of California Los Angeles,Los Angeles, CA, USA 6Washington University In Saint Louis,Saint Louis, MO, USA
~~Introduction: Institution wide efforts in quality improvement have improved patient safety across disciplines. Achieving improvements in surgical outcomes may be dependent on department specific factors. The aim of this study was to determine if outcomes in children’s surgical subspecialties within the same institution were similar or different to outcomes in general pediatric surgery.
Methods: 2011-2012 ACS-NSQIP-P data were sorted into six specialties; general surgery, plastics, urology, otolaryngology, orthopedics and neurosurgery among 50 hospitals. 30-day composite morbidity (occurrence of 17 postoperative complications) was the primary outcome. Multivariate hierarchical models were used to estimate risk-adjusted hospital odds ratio of morbidity for each specialty. Spearman correlation, ranking of these odds ratios was performed. General surgery was treated as the reference since it had the largest case volume.
Results: Correlations in an institutions general surgery outcomes, and specialty outcomes were moderate (R=0.3-0.5, p<0.01) with the exception of orthopedics (R=0.1, p=0.5). Median difference in hospital performance rank between general surgery and specialties ranged from 8-14 ranks. Median difference in hospital decile performance ranking ranged from 1-3 deciles. 1-2 hospitals ranked in the best decile in general surgery were also in the best decile in specialty care for a 20-40% concordance in best decile designation. 0-2 hospitals ranked in the worst decile in general surgery were also in the worst decile in specialty care for a 0-40% concordance in worst decile designation. There was some overlap in risk adjusted specialty performance within hospitals but outlier departments within hospitals were observed (Figure).
Conclusion: There is variability in surgical outcomes between specialties within the same institution. This suggests that unique department specific factors may drive surgical outcomes. Every hospital likely has an area which could be the focus of quality improvement.
Figure Legend:
Odds ratio is given in order for general surgery, urology, otolaryngology, plastics, neurosurgery and orthopedics for each hospital ranked by dummy identifier.
