J. Y. Liu1,2, Q. L. Hu1,3, R. P. Merkow4, K. Y. Bilimoria4, Y. Hu4,5, C. Y. Ko1,3, F. Abdullah4,5, M. V. Raval4,5 1American College of Surgeons,Division Of Research And Optimal Patient Care,Chicago, IL, USA 2Emory University,Department Of Surgery,Atlanta, GA, USA 3David Geffen School of Medicine at University of California Los Angeles,Department Of Surgery,Los Angeles, CA, USA 4Northwestern University,Department Of Surgery,Chicago, IL, USA 5Ann and Robert H. Lurie Children’s Hospital,Division Of Pediatric Surgery,Chicago, IL, USA
Introduction: Approximately 450,000 children undergo surgery annually in the United States. While the complication rates following surgery in both children and adults have been well described using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and NSQIP-Pediatric (NSQIP-P) registries, there have been no direct comparisons of outcomes between adults and children undergoing similar procedures. Our objective was to describe similarities and differences in postoperative outcomes between children and adults undergoing four common surgical procedures.
Methods: Utilizing data from NSQIP and NSQIP-P from 2013 – 2017, we identified patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, thyroidectomy, and colectomy. Propensity score matching on gender, race, ASA class, surgical indication using ICD9/10 diagnosis codes, and procedure type was performed resulting in matched cohorts of children and adults. Outcomes of interest included surgical site infection (SSI), readmission rates, mortality, and hospital length of stay (LOS), and were analyzed utilizing χ2 and student’s t-test with statistical significance defined as p<0.05.
Results: Among 79,866 patients from 812 hospitals, there were significant differences in postoperative outcomes evaluated in all procedure types (Table 1). Compared to adults, children had higher rates of SSI following laparoscopic appendectomy (4.12% vs 1.40%), SSI following laparoscopic cholecystectomy (0.96% vs 0.66%), readmission following laparoscopic appendectomy (4.26% vs 2.47%), and longer LOS in all procedure types (Table 1). In adults, 30-day mortality was higher following laparoscopic appendectomy (0.03% vs 0.00%) and colectomy (1.77% vs 0.59%) than in children.
Conclusion: Compared to adults undergoing similar surgical procedures, children demonstrate different complication and outcome profiles, illustrating the unique needs of children undergoing surgery. Simultaneously, our results demonstrate that adult focused quality improvement efforts through SSI prevention bundles and enhanced recovery protocols aimed at reducing postoperative LOS need to be proactively expanded to children’s surgery.
