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Multicenter Study
. 2025 Jan 1;281(1):170-175.
doi: 10.1097/SLA.0000000000006246. Epub 2024 Feb 22.

Utility of a Benchmarking Report for Balancing Infection Prevention and Antimicrobial Stewardship in Children With Complicated Appendicitis

Shannon L Cramm  1 , Dionne A Graham  2 , Martin L Blakely  3 , Robert A Cowles  4 , Shaun M Kunisaki  5 , Aaron M Lipskar  6 , Robert T Russell  7 , Matthew T Santore  8 , Jennifer R DeFazio  9 , Cornelia L Griggs  10 , Danielle I Aronowitz  11 , Myron Allukian  11 , Brendan T Campbell  12 , Nicole M Chandler  13 , Devon T Collins  14 , Sarah J Commander  15 , Katerina Dukleska  13 , Justice C Echols  16 , Joseph R Esparaz  7 , Christina Feng  17 , Claire Gerall  18 , David N Hanna  3 , Olivia A Keane  8 , Sean E McLean  18 , Elizabeth Pace  19 , Stefan Scholz  19 , Shelby R Sferra  5 , Elisabeth T Tracy  20 , Sacha Williams  21 , Lucy Zhang  4 , Katherine He  1 , Shawn J Rangel  1 ; Eastern Pediatric Surgery Network
Affiliations
Multicenter Study

Utility of a Benchmarking Report for Balancing Infection Prevention and Antimicrobial Stewardship in Children With Complicated Appendicitis

Shannon L Cramm et al. Ann Surg. .

Abstract

Objective: To develop a severity-adjusted, hospital-level benchmarking comparative performance report for postoperative organ space infection (OSI) and antibiotic utilization in children with complicated appendicitis.

Background: No benchmarking data exist to aid hospitals in identifying and prioritizing opportunities for infection prevention or antimicrobial stewardship in children with complicated appendicitis.

Methods: This was a multicenter cohort study using National Surgical Quality Improvement Program-Pediatric data from 16 hospitals participating in a regional research consortium, augmented with antibiotic utilization data obtained through supplemental chart review. Children with complicated appendicitis who underwent appendectomy from July 1, 2015 to June 30, 2020 were included. Thirty-day postoperative OSI rates and cumulative antibiotic utilization were compared between hospitals using observed-to-expected (O/E) ratios after adjusting for disease severity using mixed-effect models. Hospitals were considered outliers if the 95% CI for O/E ratios did not include 1.0.

Results: A total of 1790 patients were included. Overall, the OSI rate was 15.6% (hospital range: 2.6% to 39.4%) and median cumulative antibiotic utilization was 9.0 days (range: 3.0 to 13.0). Across hospitals, adjusted O/E ratios ranged 5.7-fold for OSI (0.49 to 2.80, P = 0.03) and 2.4-fold for antibiotic utilization (0.59 to 1.45, P < 0.01). Three (19%) hospitals were outliers for OSI (1 high and 2 low performers), and 8 (50%) were outliers for antibiotic utilization (5 high and 3 low utilizers). Ten (63%) hospitals were identified as outliers in one or both measures.

Conclusions: A comparative performance benchmarking report may help hospitals identify and prioritize quality improvement opportunities for infection prevention and antimicrobial stewardship, as well as identify exemplar performers for dissemination of best practices.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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