Development and Utility of a Hospital-Level Comparative Performance Report Card for Surgical Prophylaxis Utilization in Non-Emergent Pediatric Surgery
Katherine He, MD, MS1, Marie Iwaniuk, PhD2,, Michael J. Goretsky, MD3, Robert A. Cina, MD4, Jacqueline M. Saito, MD, MSCI5, Bruce Hall, MD, PhD, MBA5, Catherine Grant, BSN, RN2, Mark E. Cohen, PhD2, Shawn J. Rangel, MD, MSCE1
1Boston Children’s Hospital, Boston, MA; 2American College of Surgeons, Chicago, IL; 3Children’s Hospital of the King’s Daughters, Norfolk, VA; 4The Medical University of South Carolina, Charlestown, SC; 5Washington University St. Louis School of Medicine, St. Louis, MI
Background:
Antimicrobial stewardship and surgical site infection (SSI) prevention are important in optimizing surgical antimicrobial prophylaxis. We created a standardized report card to identify quality improvement opportunities around these goals.
Methods:
From 6/2019-6/2020, 90 hospitals in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric) antibiotic stewardship collaborative collected non-emergent case data. Prophylaxis measures included timing compliance, compliance with antibiotic spectrum guidelines, and prophylaxis utilization following incision closure. Incisional and organ space infection rates were included as balancing measures. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for each measure, adjusted for comorbidities and procedure-mix. Hospitals were considered performance outliers if their adjusted 95% confidence interval did not include 1.0.
Results:
10,398 patients were analyzed. Variation in adjusted ORs ranged from 2.9-fold for organ space SSI to 82-fold for non-compliance with appropriate spectrum antibiotics (Table). 31.1% of hospitals were a low performer for at least one measure and 45.6% a high performer for at least one measure. Only 2 hospitals (2.2%) were identified as an outlier for the SSI measures (Table).
Conclusion:
Variation in antibiotic prophylaxis among hospitals was considerable, suggesting substantial utility for a report card in identifying hospitals with opportunities for improvement and exemplar hospitals. Although SSI rates and variability were low, inclusion of SSI rates allows monitoring as stewardship efforts are implemented.
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