Focusing quality improvement initiatives in pediatric plastic surgery-A descriptive study using the pediatric national surgical quality improvement program

Background: The American College of Surgeons National Surgical Quality Improvement Program-Pediatrics uses a risk-adjusted, case-mix-adjusted methodology to compare quality of hospitallevel 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.