TY - JOUR
T1 - The contribution of practice variation to length of stay for children with perforated appendicitis
AU - Gross, Teresa S.
AU - McCracken, Courtney
AU - Heiss, Kurt F.
AU - Wulkan, Mark L.
AU - Raval, Mehul V.
N1 - Funding Information:
TSG is supported by the + Children's Pediatric Research Trust, Children's Healthcare of Atlanta, and the Department of Surgery at Emory University. This study was performed using the ACS NSQIP-P data and we acknowledge the diligent efforts clinical reviewers at the participating sites. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This work was presented, in part, at the American College of Surgeons National Surgical Quality Improvement Annual Meeting in Chicago, IL, July 2015. National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. TL1 Award Number TL1TR000456. MVR is supported by the Emory
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background Postoperative length of stay (pLOS) is an easily tracked outcome that reflects health care efficiency and resource utilization. The purpose of this study was to determine the contribution of practice variation on pLOS for children with perforated appendicitis. Methods Children ages 2–18 years with appendectomy for complicated appendicitis were selected from the National Surgical Quality Improvement Program-Pediatric. Extended pLOS (EpLOS) was defined as ≥ 7 days (75th percentile). The contribution of comorbidities, operative traits, and postoperative complications to EpLOS was evaluated using regression models and matched subgroup analyses. Results Of 2585 children with complicated appendicitis in our study, 835 had EpLOS. Regression analysis found that EpLOS was associated with extended operative time (odds ratio (OR) 1.99; 95% confidence interval (CI) 1.63–2.44), dehiscence (OR 13.19; 95% CI 1.52–114.23), wound infection (OR 7.39; 95% CI 2.63–20.80), organ space infection (OR 92.51; 95% CI 34.03–251.50), and pneumonia (OR 4.55; 95% CI 1.06–19.44). Over three-fourths of the variation in pLOS could not be explained by preoperative, intraoperative, or postoperative factors. Conclusions There is significant variation in pLOS for children undergoing appendectomy that is not accounted for by comorbidities, operative traits, or complications indicating an opportunity to improve outcomes through modifying practice patterns.
AB - Background Postoperative length of stay (pLOS) is an easily tracked outcome that reflects health care efficiency and resource utilization. The purpose of this study was to determine the contribution of practice variation on pLOS for children with perforated appendicitis. Methods Children ages 2–18 years with appendectomy for complicated appendicitis were selected from the National Surgical Quality Improvement Program-Pediatric. Extended pLOS (EpLOS) was defined as ≥ 7 days (75th percentile). The contribution of comorbidities, operative traits, and postoperative complications to EpLOS was evaluated using regression models and matched subgroup analyses. Results Of 2585 children with complicated appendicitis in our study, 835 had EpLOS. Regression analysis found that EpLOS was associated with extended operative time (odds ratio (OR) 1.99; 95% confidence interval (CI) 1.63–2.44), dehiscence (OR 13.19; 95% CI 1.52–114.23), wound infection (OR 7.39; 95% CI 2.63–20.80), organ space infection (OR 92.51; 95% CI 34.03–251.50), and pneumonia (OR 4.55; 95% CI 1.06–19.44). Over three-fourths of the variation in pLOS could not be explained by preoperative, intraoperative, or postoperative factors. Conclusions There is significant variation in pLOS for children undergoing appendectomy that is not accounted for by comorbidities, operative traits, or complications indicating an opportunity to improve outcomes through modifying practice patterns.
KW - Determinants of length of stay appendectomy
KW - Enhanced recovery after surgery
KW - Length of stay
KW - Perforated appendicitis
KW - Postoperative
KW - Postoperative protocol
KW - Practice variation
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U2 - 10.1016/j.jpedsurg.2016.01.016
DO - 10.1016/j.jpedsurg.2016.01.016
M3 - Article
C2 - 26891834
AN - SCOPUS:84990978768
VL - 51
SP - 1292
EP - 1297
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 8
ER -