A. L. Schwartz1, M. M. Nourian1, B. T. Bucher1 1University Of Utah,Division Of Pediatric Surgery,Salt Lake City, UT, USA
Introduction:
Retained foreign bodies (RFB) discovered after surgery are documented as an Agency for Health Care Quality and Research Patient Safety Indicator (AHRQ PSI) for hospital quality. The AHRQ PSI measures absolute numbers and is not controlled for hospital or procedure volume. Several studies have documented the contributing factors to retained foreign bodies during surgery in adults; however, there is little data in children undergoing surgical procedures. The goal of this study is to identify a cohort of children with retained foreign bodies at U.S. children’s hospitals.
Methods:
We performed a retrospective case series study of pediatric patients that underwent surgery with RFB at 49 U.S. children’s hospitals using the Pediatric Health Information System Database (PHIS) from 2004 to 2015. Patients were defined as having RFB based on the AHRQ PSI definition. Patients with RFB present on admission were excluded from the study. Patient demographics, clinical, procedural, and hospital characteristics were collected.
Results:
There were a total of 447 post-surgical patients who were identified with RFB from 2004-2015. The majority of patients were between 2-12 years of age (36%), male (56%), Caucasian (64%), and non-Hispanic (43%). There was an equal share between Medicaid (40%) and Commercial Insurance (46%). Admissions were equally distributed between elective (37%) and emergent (40%). As expected, the patients were high acuity with 52% requiring NICU or PICU admission and 37% requiring mechanical ventilation. At least one complex chronic condition was present in 72% of the children in the cohort. Of the 1,257 procedures performed, the majority of procedures were operations on the digestive system (22%), cardiovascular system (20%), and respiratory system (19%). The median (IQR) number of procedures per patient was 1 (IQR 1-2). The hospital length of stay for a patient with RFB was 6±20 days. The majority of patients were discharged home (86%) and the mortality rate was 2.7%. The number of RFB per hospital per year decreased from 1.8 to 0.5 during the study period.
Conclusion:
We have identified a large cohort of children with a retained foreign body after surgery based on the AHRQ PSI. The majority of children had complex chronic medical conditions and high acuity hospital admissions. The majority of procedures with a retained foreign body in pediatric patients involve operations on the digestive system, cardiovascular system, and respiratory system. This study helps define a cohort of children who are at risk for retained foreign bodies. Future studies are needed to identify patient and procedure specific factors related to RFB in children.
