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S15-7
(P)
OPPORTUNITIES FOR QUALITY IMPROVEMENT AND OUTCOME MEASUREMENT IN
PEDIATRIC UROLOGY
David CHU, Douglas CANNING and Gregory TASIAN
Children's Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA
PURPOSE
Quality assessment in surgical care is increasingly emphasized. We assessed 30-day adverse event rates and relative
contributions to morbidity for procedures in pediatric urology surgery.
MATERIAL AND METHODS
The American College of Surgeons’ National Surgical Quality Improvement Program Pediatric database contains
perioperative records from 2012-2013 from over 50 participating hospitals. Individual 30-day adverse events, composite
morbidity, composite serious adverse events, and composite hospital-acquired infections were compiled. Clinically-
related procedure groups were evaluated for incidence of complications.
RESULTS
A total of 5437 patients underwent 1 of 40 selected urologic procedures, grouped into procedures related to bladders,
kidneys, ureters, penis/urethras, testicles, and urinary diversions. Overall complication rate was 3.5%. Individual 30-
day adverse event rates were highest for unplanned hospital readmission (3%), urinary tract infection (1.9%),
reoperation (1.4%), and surgical site infection (1%). The highest rates of composite morbidity were seen for patients
undergoing bladder-related procedures (19.6%) followed by urinary diversions (11.1%). The highest rates of serious
adverse events were seen in patients undergoing urinary diversion (15.9%) followed by ureteral procedures (15.1%).
Hospital-acquired infection rates were highest in patients undergoing bladder procedures (12.5%) and urinary diversions
(11.1%). The single procedure with the greatest complication rate (61% composite morbidity) was closure of bladder
exstrophy.
CONCLUSIONS
In pediatric urology, postoperative complication rates are overall low. Measurement of outcomes specific to pediatric
urology procedures should center on reduction of unplanned hospitalizations and urinary tract infections. Closure of
bladder exstrophy represents a specific procedure with the greatest potential for improvement.