Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

Kennedy, Angeliki; Bakir, Christina; Brauer, Carmen A.

doi:10.1007/s11999-011-2060-2

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…Therefore, there is an increasing demand to define measures of outcomes to improve surgical quality. Most used quality indicators in pediatric surgery are mortality, morbidity, unplanned readmissions, and the incidence of postoperative complications [ 3 , 4 ]. Many of those, such as mortality and morbidity, are often not applicable to the pediatric population because the incidence of those events is too low in children [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

2022

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Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

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Section: Introductionmentioning

confidence: 99%

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

2022

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“…Excluded as the study design was not in the inclusion criteria: systematic review article Kennedy et al (53) Quality indicators in paediatric surgery: a systematic review…”

Section: Discussionmentioning

confidence: 99%

Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review

Ousey

Edward

Lui

2013

International Wound Journal

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The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery.

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“…36 In a systematic review, Kennedy et al found that mortality and postoperative complications were the most commonly reported quality indicators after pediatric orthopedic surgery. 37 While process measures may be employed in CEAs, there is no feasible way to convert them to QALY or utility, precluding their use in CUAs.…”

Section: Outcome Measures and Process Measuresmentioning

confidence: 99%

Health Economics in Pediatric Orthopaedic Surgery

Orman

Testa

Patel

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Healthcare expenditures in the United States continue to rise without corresponding improvements in outcomes. Because of this, there is increasing pressure on physicians to consider the economic impacts of their medical decisions. Unfortunately, physicians in general are unfamiliar with interpreting and performing various health economic analyses. A basic understanding of health economics may help physicians understand and participate in key policy discussions which may shape the future of medicine and surgery. In the field of pediatric orthopaedics specifically, the literature involving health economic evaluation is sparse. This may be due to a combination of unfamiliarity with the topic and also difficulties with applying economic evaluation methods to the pediatric population. However, many interventions in this field are low cost with many potential benefits that accrue over a child’s long lifespan. Economic evaluation can help objectively quantify the impact of these interventions, as well as bolster responsible medical decision-making. To that end, the purpose of the current review is to introduce the pediatric orthopaedic community to commonly utilized healthcare economic tools including cost-benefit analysis, cost-effectiveness analysis, and cost-utility analysis with a focus on several key concepts including value, quality, time, cost, and discounting. To help illustrate these concepts, health economic literature relevant to pediatric orthopaedics is discussed. Finally, we highlight limitations inherent to health economic evaluations in general and those applicable to pediatric orthopaedics specifically. This discussion may help lay the groundwork for future studies and for further involvement in policy-making.

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Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

Cited by 10 publications

References 23 publications

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review

Health Economics in Pediatric Orthopaedic Surgery

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