Quality metrics for emergency abdominal surgery in children: a systematic review

Lisa A Sogbodjor; Georgina Singleton; Mark Davenport; Suellen Walker; S Ramani Moonesinghe

doi:10.1016/j.bja.2021.10.045

Quality metrics for emergency abdominal surgery in children: a systematic review

Br J Anaesth. 2022 Mar;128(3):522-534. doi: 10.1016/j.bja.2021.10.045. Epub 2021 Dec 9.

Authors

Lisa A Sogbodjor¹, Georgina Singleton², Mark Davenport³, Suellen Walker⁴, S Ramani Moonesinghe²

Affiliations

¹ Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK. Electronic address: amaki.sogbodjor@gosh.nhs.uk.
² Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
³ Department of Paediatric Surgery, King's College Hospital, London, UK.
⁴ Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond St Institute of Child Health, London, UK.

PMID: 34895715
DOI: 10.1016/j.bja.2021.10.045

Abstract

Background: There is variation in care quality and outcomes for children undergoing emergency abdominal surgery, such as appedectomy. Addressing this requires paediatric-specific quality metrics. The aim of this study was to identify perioperative structure and process measures that are associated with improved outcomes for these children.

Methods: We performed a systematic review searching MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar for articles published between January 1, 1980 and September 29, 2020 about the perioperative care of children undergoing emergency abdominal surgery. We also conducted secondary searching of references and citations, and we included international professional publications.

Results: We identified and analysed 383 peer-reviewed articles and 18 grey literature publications. High-grade evidence pertaining to the perioperative care of this patient group is limited. Most of the evidence available relates to improving diagnostic accuracy using preoperative blood testing, imaging, and clinical decision tools. Processes associated with clinical outcomes include time lapse between time of presentation or initial assessment and surgery, and the use of particular analgesia and antibiotic protocols. Structural factors identified include hospital and surgeon caseload and the use of perioperative care pathways.

Conclusions: This review summarises the structural and process measures associated with outcome in paediatric emergency abdominal surgery. Such measures provide a means of evaluating care and identifying areas of practice that require quality improvement, especially in children with appendicitis.

Clinical trial registration: PROSPERO CRD42017055285.

Keywords: acute abdomen; appendicitis; child; health services research; perioperative care; quality of healthcare; surgical procedure.

Publication types

Systematic Review

MeSH terms

Abdomen / surgery*
Critical Pathways
Evidence-Based Medicine / methods
Hospitals
Humans
Perioperative Care
Surgeons