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Focusing Quality Improvement Initiatives in Pediatric Plastic Surgery

A Descriptive Study Using the Pediatric National Surgical Quality Improvement Program

Flath-Sporn, Susan J. MPH; Yorlets, Rachel R. MPH; Rangel, Shawn J. MD, MSCE; Stey, Anne M. MD, MSc; Redett, Richard J. MD; Urata, Mark M. MD, DDS; Meara, John G. MD, DMD; Taghinia, Amir H. MD, MPH

Journal of Craniofacial Surgery: March 2016 - Volume 27 - Issue 2 - p 277–281
doi: 10.1097/SCS.0000000000002419
Original Articles

Background: The American College of Surgeons National Surgical Quality Improvement Program - Pediatrics uses a risk-adjusted, case-mix-adjusted methodology to compare quality of hospital-level surgical performance. This paper aims to focus quality improvement efforts on diagnoses that have large patient volume and high morbidity for pediatric plastic surgery.

Methods: Frequency statistics were generated for a cohort of patients under age 18 who underwent plastic surgery procedures at participating National Surgical Quality Improvement Program - Pediatrics hospitals from January 1, 2011 to December 31, 2012.

Results: Cleft lip and palate procedures were the leading contributor to serious adverse events (45.00%), and the second largest contributor to composite morbidity (37.73%) as well as hospital-acquired infections (21.23%).

Conclusions: When focusing resources for relevant data collection and quality improvement efforts, it is important to consider procedures that are both substantial volume and result in relatively higher morbidity. A balance must be made between what is relevant to collect and what is feasible given finite resources. Cleft lip and/or palate procedures might provide an ideal opportunity for coordinated efforts that could ultimately improve care for pediatric plastic surgery patients.

*Department of Plastic and Oral Surgery

Department of General Surgery, Boston Children's Hospital, Boston, MA

Department of General Surgery, Mount Sinai Medical Center, New York, NY

§Division of Plastic and Reconstructive Surgery, Johns Hopkins Health System, Baltimore, MD

||Children's Hospital Los Angeles, Plastic and Maxillofacial Surgery, Los Angeles, CA.

Address correspondence and reprint requests to Amir H. Taghinia, MD, MPH, Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115; E-mail:

Received 28 September, 2015

Accepted 1 December, 2015

SJ Flath-Sporn and RR Yorlets are co-authors.

AMS was supported by The Robert Wood Johnson Foundation Clinical Scholars program and the U.S. Department of Veterans Affairs.

The authors report no conflicts of interest.

© 2016 by Mutaz B. Habal, MD.