Utility of a Benchmarking Report for Balancing Infection Prevention and Antimicrobial Stewardship in Children with Complicated Appendicitis.

Autor:	Cramm SL; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Graham DA; Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA., Blakely ML; Division of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN., Cowles RA; Department of Pediatric Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT., Kunisaki SM; Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, MD., Lipskar AM; Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY., Russell RT; Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL., Santore MT; Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA., DeFazio JR; Division of Pediatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Vagelos College of Physcians and Surgeons, New York, NY., Griggs CL; Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA., Aronowitz DI; Division of Pediatric, General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA., Allukian M; Division of Pediatric, General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA., Campbell BT; Department of Surgery, Connecticut Children's Hospital, Hartford, CT., Chandler NM; Division of Pediatric Surgery, Johns Hopkin's All Children's Hospital, St. Petersburg, FL., Collins DT; Department of Surgery, Children's National Hospital, Washington, D.C., Commander SJ; Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC., Dukleska K; Division of Pediatric Surgery, Johns Hopkin's All Children's Hospital, St. Petersburg, FL., Echols JC; Division of Pediatric Surgery, University of North Carolina Health System, University of North Carolina School of Medicine, Chapel Hill, NC., Esparaz JR; Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL., Feng C; Department of Surgery, Children's National Hospital, Washington, D.C., Gerall C; Department of Surgery, UT Health San Antonio, San Antonio, TX., Hanna DN; Division of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN., Keane OA; Department of Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, GA., McLean SE; Department of Surgery, UT Health San Antonio, San Antonio, TX., Pace E; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Scholz S; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA., Sferra SR; Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins School of Medicine, Baltimore, MD., Tracy ET; Department of Surgery, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, NC., Williams S; Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL., Zhang L; Department of Pediatric Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT., He K; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA., Rangel SJ; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Feb 22. Date of Electronic Publication: 2024 Feb 22.
DOI:	10.1097/SLA.0000000000006246
Abstrakt:	Objective: To develop a severity-adjusted, hospital-level benchmarking comparative performance report for postoperative organ space infection and antibiotic utilization in children with complicated appendicitis. Background: No benchmarking data exist to aid hospitals in identifying and prioritizing opportunities for infection prevention or antimicrobial stewardship in children with complicated appendicitis. Methods: This was a multicenter cohort study using NSQIP-Pediatric data from 16 hospitals participating in a regional research consortium, augmented with antibiotic utilization data obtained through supplemental chart review. Children with complicated appendicitis who underwent appendectomy from 07/01/2015 to 06/30/2020 were included. Thirty-day postoperative OSI rates and cumulative antibiotic utilization were compared between hospitals using observed-to-expected (O/E) ratios after adjusting for disease severity using mixed effects models. Hospitals were considered outliers if the 95% confidence interval for O/E ratios did not include 1.0. Results: 1790 patients were included. Overall, the OSI rate was 15.6% (hospital range: 2.6-39.4%) and median cumulative antibiotic utilization was 9.0 days (range: 3.0-13.0). Across hospitals, adjusted O/E ratios ranged 5.7-fold for OSI (0.49-2.80, P=0.03) and 2.4-fold for antibiotic utilization (0.59-1.45, P<0.01). Three (19%) hospitals were outliers for OSI (1 high and 2 low performers), and eight (50%) were outliers for antibiotic utilization (5 high and 3 low utilizers). Ten (63%) hospitals were identified as outliers in one or both measures. Conclusions: A comparative performance benchmarking report may help hospitals identify and prioritize quality improvement opportunities for infection prevention and antimicrobial stewardship, as well as identify exemplar performers for dissemination of best practices. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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