TY - JOUR
T1 - Hospital and procedure incidence of pediatric retained surgical items
AU - Wang, Bo
AU - Tashiro, Jun
AU - Perez, Eduardo A.
AU - Lasko, David S.
AU - Sola, Juan E.
N1 - Funding Information:
The KID is a national sample of pediatric inpatient discharges sponsored by the Healthcare Cost and Utilization Project and the U.S. Agency for Healthcare Research and Quality. Comprised of approximately 7 million weighted cases per triennial release, KID provides valuable information about clinical end points associated with pediatric admissions throughout the United States. Using the data available in KID, studies have been performed to explore determinants of survival in pediatric surgery [10,11] , ligation of patent ductus arteriosus [12] , repair of esophageal atresia and tracheoesophageal fistula [13] , extracorporeal membrane oxygenation [14] , congenital diaphragmatic hernia [15] , or resource utilization in cleft lip repair [16] among others. For this study, cases of RSI were determined using the International Classification of Diseases, Ninth Revision, Clinical Modification codes E871.0, E871.1, E871.4, 998.4, and 998.7. Additionally, we subanalyzed complex RSI cases as cases requiring surgical removal of foreign body from the peritoneum (International Classification of Diseases, Ninth Revision, Clinical Modification procedure 54.92). Patients were limited to the age of <18 y and identified from the 1997, 2000, 2003, 2006, and 2009 KID data sets. Demographic information regarding average age, length of stay (LOS), and cost of hospitalization were calculated. Overall incidence of RSI were calculated both by per 100,000 admissions and per 100,000 procedures. Furthermore, RSI incidence was analyzed based on hospital bedsize, teaching status, region, and ownership and rural versus metropolitan location based on per 100,000 admissions under the assumption that procedures performed per admission has remained stable overtime in the national pediatric population. Hospital bedsize was defined using Healthcare Cost and Utilization Project's definition ( http://www.hcup-us.ahrq.gov/db/vars/hosp_bedsize/nisnote.jsp ). It is adjusted based on hospital location and its teaching status. Rates per analysis groups were calculated using denominator information from the National Statistics on Children provided by HCUPnet [17] . Continuous variables are presented as mean value ± standard deviation. Analyses were performed using standard statistical methods, namely chi-squared analyses for categorical variables. Currency values from all years were standardized to 2009 U.S. currency, and all cases were weighted to project national estimates. Statistical significance is defined at alpha level 0.05. 3
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background Prevention of retained surgical items (RSIs) is the main objective of the World Health Organization "Guidelines for Safe Surgery" (WHO/GSS) 2008 to improve patient safety. Methods We analyzed Kids' Inpatient Database 1997-2009 for RSI in patients aged <18 y. Incidence of RSI was calculated by per 100,000 admissions and per 100,000 procedures. The incidence was analyzed based on hospital bedsize, teaching status, region, and ownership and rural versus metropolitan location based on per 100,000 admissions. Results Overall, 713 cases were identified with a mean (standard deviation) age of 8.31 y (6.62), length of stay of 13 d (20), and total charges of $91,321 (155,054). RSI occurred at a rate of 2.22 per 100,000 admissions and 1.93 per 100,000 procedures; both rates decreased post-WHO/GSS implementation versus pre-WHO/GSS, P < 0.005. On average, public or children's hospitals reported the highest RSI rates (8.89 and 6.07/100,000 admissions, respectively). Small and medium bedsize hospitals had lower rates of RSI post-WHO/GSS, P < 0.05. Nonteaching, non-children's, or public hospitals reported lower rates post-WHO/GSS, P < 0.003. Private (nonprofit) hospitals reported higher rates post-WHO/GSS, P < 0.001. Facilities in the southern United States or in metropolitan areas reported lower rates post-WHO/GSS, P < 0.02. A subanalysis of 107 cases requiring surgical removal demonstrated that fundoplications had the highest rate of RSI, followed by gastric procedures, laparotomy, bile duct procedures, lysis of adhesions, and abdominal wall repair. Conclusions RSI rates have decreased overall after the introduction of the WHO/GSS. The largest reductions have occurred in public or nonteaching hospitals. Only private (nonprofit) hospitals reported increases in RSI since 2008. Higher rates of RSI are associated with fundoplications and other gastric procedures.
AB - Background Prevention of retained surgical items (RSIs) is the main objective of the World Health Organization "Guidelines for Safe Surgery" (WHO/GSS) 2008 to improve patient safety. Methods We analyzed Kids' Inpatient Database 1997-2009 for RSI in patients aged <18 y. Incidence of RSI was calculated by per 100,000 admissions and per 100,000 procedures. The incidence was analyzed based on hospital bedsize, teaching status, region, and ownership and rural versus metropolitan location based on per 100,000 admissions. Results Overall, 713 cases were identified with a mean (standard deviation) age of 8.31 y (6.62), length of stay of 13 d (20), and total charges of $91,321 (155,054). RSI occurred at a rate of 2.22 per 100,000 admissions and 1.93 per 100,000 procedures; both rates decreased post-WHO/GSS implementation versus pre-WHO/GSS, P < 0.005. On average, public or children's hospitals reported the highest RSI rates (8.89 and 6.07/100,000 admissions, respectively). Small and medium bedsize hospitals had lower rates of RSI post-WHO/GSS, P < 0.05. Nonteaching, non-children's, or public hospitals reported lower rates post-WHO/GSS, P < 0.003. Private (nonprofit) hospitals reported higher rates post-WHO/GSS, P < 0.001. Facilities in the southern United States or in metropolitan areas reported lower rates post-WHO/GSS, P < 0.02. A subanalysis of 107 cases requiring surgical removal demonstrated that fundoplications had the highest rate of RSI, followed by gastric procedures, laparotomy, bile duct procedures, lysis of adhesions, and abdominal wall repair. Conclusions RSI rates have decreased overall after the introduction of the WHO/GSS. The largest reductions have occurred in public or nonteaching hospitals. Only private (nonprofit) hospitals reported increases in RSI since 2008. Higher rates of RSI are associated with fundoplications and other gastric procedures.
KW - Patient safety
KW - Pediatrics
KW - World Health organization
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U2 - 10.1016/j.jss.2015.03.054
DO - 10.1016/j.jss.2015.03.054
M3 - Article
C2 - 25908101
AN - SCOPUS:84940720760
VL - 198
SP - 400
EP - 405
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
IS - 2
ER -