Paediatric basket

Umbilical Hernia Complication rate

Metric

The percentage of children with Umbilical Hernia complications.

Numerator

• Umbilical Hernia: OPCS code T24 and T97
• Spells with any of the following complications:

OPCS codes

• Drainage of wound abscess: S47.2, S47.4

OR ICD10 codes

• Haemorrhage and haematoma complicating a procedure ICD10: T81.0

Patients aged 19 years old and under at the start of their admission

Denominator

• Umbilical Hernia: OPCS code T24 and T97
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

30 day standardised mortality ratio for Emergency Appendicectomy

Metric

The ratio of the observed number of in-hospital child deaths within 30 days of the date of the main procedure to the expected number of deaths, multiplied by 100.

Numerator

Death in hospital within 30 days of the date of main procedure (or date of admission if missing/invalid) in this spell. Death is flagged on spells with method of discharge as death (DISMETH=4 and 5), defined by specific diagnosis codes for the primary diagnosis of the spell.

• Emergency Appendicectomy Definition:

Emergency appendicectomy in any procedure field accompanied by a procedure code for laparoscopic approach to abdominal cavity

Emergency appendicectomy:

H01 - Emergency excision of appendix

H028 - Other specified other excision of appendix

H029 - Unspecified other excision of appendix

Laparoscopic approach to abdominal cavity:

Y751 - Laparoscopically assisted approach to abdominal cavity

Y752 - Laparoscopic approach to abdominal cavity NEC

• Patients aged 19 years old and under at the start of their admission

Denominator

• Emergency Appendicectomy Definition:

Emergency appendicectomy in any procedure field accompanied by a procedure code for laparoscopic approach to abdominal cavity

Emergency appendicectomy:

H01 - Emergency excision of appendix

H028 - Other specified other excision of appendix

H029 - Unspecified other excision of appendix

Laparoscopic approach to abdominal cavity:

Y751 - Laparoscopically assisted approach to abdominal cavity

Y752 - Laparoscopic approach to abdominal cavity NEC

• Patients aged 19 years old and under at the start of their admission

Expected number of in-hospitals deaths derived from logistic regression, adjusting for factors to indirectly standardise for difference in case-mix.

Adjustments are made for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Primary procedure
• Co-morbidities (Dr Foster methodology, see Appendix A)
• Number of previous emergency admissions
• Year of discharge (financial year)
• Palliative care (whether the patient is being treated in specialty of palliative care)
• Month of admission
• Ethnicity
• Source of admission

Data Source / Time frame

SUS - April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of deaths by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has an RR of 100, that means that the number of patients who died is exactly as it would be expected taking into account the standardisation factors. An RR above 100 means more patients died than would be expected; one below 100 means that fewer than expected died.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Emergency Appendicectomy Adjusted Average Length of Stay

Metric

Adjusted average length of stay for children receiving an emergency appendicectomy.

Observed

Average length of stay for all discharges among cases meeting the inclusion and exclusion rules for the denominator.

Expected

Expected length of stay is adjusted to indirectly standardise for differences in co-morbidities.

• Inpatients only
• Emergency appendicectomy in any procedure field accompanied by a procedure code for laparoscopic approach to abdominal cavity

Emergency appendicectomy:

H01 - Emergency excision of appendix

H028 - Other specified other excision of appendix

H029 - Unspecified other excision of appendix

Laparoscopic approach to abdominal cavity:

Y751 - Laparoscopically assisted approach to abdominal cavity

Y752 - Laparoscopic approach to abdominal cavity NEC

• Patients aged 19 years old and under at the start of their admission

Time frame

April 2009- March 2010

Basis

Acute Trust (excluding specialists)

Statistical methods used

Indirect standardisation, adjusted for:

• age
• sex
• deprivation (carstairs qunitiles, 2001)
• Co-morbidities (Dr Foster methodology, see Appendix A)

Emergency Appendicectomy Readmission Rate

Metric

The rate (expressed as a percentage) of children receiving emergency appendicectomies that result in a second operation being performed within a year.

Numerator

All spells that occur within a year of the patient’s emergency appendicectomy (the index procedure) where drainage of abscess of appendix, percutaneous abscess drainage, drainage/incision of lesion, or freeing of adhesions are coded in any procedure field.

Drainage of abscess of appendix:

H031 - Drainage of abscess of appendix

H032 - Drainage of appendix NEC

H038 - Other specified other operations on appendix

H039 - Unspecified other operations on appendix

T343 - Open drainage of abdominal abscess NEC

Percutaneous abscess drainage:

T451 - Image controlled percutaneous drainage of subphrenic abscess

T452 - Image controlled percutaneous drainage of pelvic abscess

T453 - Image controlled percutaneous drainage of abdominal abscess NEC

Drainage/Incision of lesion:

S472 - Drainage of lesion of skin NEC

S474 - Incision of lesion of skin NEC

Freeing of adhesions:

T413 - Freeing of adhesions of peritoneum

T415 - Freeing of extensive adhesions of peritoneum

T423 - Endoscopic division of adhesions of peritoneum

All spells that occur within a year of the patient’s emergency appendicectomy (the index procedure) where adhesive obstruction is coded in any diagnosis field.

Adhesive Obstruction:

K565 - Intestinal adhesions [bands] with obstruction

K660 - Peritoneal adhesions

Denominator

• Emergency appendicectomy in any procedure field accompanied by a procedure code for laparoscopic approach to abdominal cavity

Emergency appendicectomy:

H01 - Emergency excision of appendix

H028 - Other specified other excision of appendix

H029 - Unspecified other excision of appendix

Laparoscopic approach to abdominal cavity:

Y751 - Laparoscopically assisted approach to abdominal cavity

Y752 - Laparoscopic approach to abdominal cavity NEC

• Patients aged 19 years old and under at the start of their admission

Data Source

SUS - CDS

Time frame

Discharge for the index emergency appendicectomy procedure must have occurred between April 2008 and March 2009.

Basis

Acute Trust

Statistical methods used

Logistic regression model, adjusted for the following factors:

• method of admission
• age
• Severity using the following ICD10 codes; K350, Acute appendicitis with generalised peritonitis and K351, Acute appendicitis.

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has an RR of 100, that means that the number of patients who were readmitted is exactly as it would be expected taking into account the standardisation factors. An RR above 100 means more patients were readmitted than would be expected; one below 100 means there were fewer than expected readmissions.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Hydrocele - % children under 2 years

Metric

The percentage of children receiving an operation on a Hydrocele sac, under 2 years old.

Numerator

• Hydrocele: OPCS code N11
• Patients aged under 2 years old at the start of their admission

Denominator

• Hydrocele: OPCS code N11
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Hydrocele Complication rate

Metric

The percentage of children receiving an operation with a Hydrocele sac with complications.

Numerator

• Hydrocele: OPCS code N11
• Spells with any of the following complications:

OPCS codes

• Drainage of wound abscess: S47.2, S47.4
• Orchidectomy N06.3

OR

ICD10 codes

• Haemorrhage and haematoma complicating a procedure ICD10: T81.0
• Patients aged 19 years old and under at the start of their admission

Denominator

• Hydrocele: OPCS code N11
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Medical Circumcision - % children under 5 years

Metric

The percentage of children receiving a medical circumcision, under 5 years old.

Numerator

• Medical circumcision: OPCS code N303
• Patients aged under 5 years old at the start of their admission

Denominator

• Medical circumcision: OPCS code N303
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Medical Circumcision Complication rate

Metric

The percentage of children receiving a medical circumcision with complications.

Numerator

• Medical circumcision: OPCS code N303
• Spells with any of the following complications:

OPCS codes

• Cauterization of lesion of penis N27.2
• Plastic operations on penis N28.8, N28.9
• Drainage of penis N32.2
• Other operations on penis N32.8, N32.9

OR

ICD10 codes

• Haemorrhage and haematoma complicating a procedure ICD10: T81.0
• Other specified disorders of penis ICD10: N48.8
• Patients aged 19 years old and under at the start of their admission

Denominator

• Medical circumcision: OPCS code N303
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

One Stage Inguinal Orchidopexy Complication rate

Metric

The percentage of children receiving a one stage inguinal orchidopexy with complications.

Numerator

Discharges among cases meeting the inclusion and exclusion rules for the denominator with any of the following complications:

OPCS codes

• Orchidectomy NEC N063
• Drainage of lesion of skin NEC S472
• Incision of lesion of skin NEC S474

OR

ICD10 codes

• Haemorrhage and haematoma complicating a procedure T810

Denominator

One stage orchidopexy codes in any procedure field accompanied by a procedure code for minimal access to abdominal cavity (Y75).

One Stage Orchidopexy:

N082 - One stage bilateral orchidopexy NEC

N092 - One stage orchidopexy NEC

• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

One Stage Inguinal Orchidopexy Reoperation rate

Metric

The percentage of spells for patients 18 and under for one stage inguinal orchidopexy that result in a second operation being performed within a year.

Numerator

All spells that resulted in another one stage inguinal orchidopexy being performed within a year of the last orchidopexy procedure (the index procedure).

Denominator

One stage orchidopexy codes in any procedure field accompanied by a procedure code for minimal access to abdominal cavity (Y75).

One Stage Orchidopexy:

N082 - One stage bilateral orchidopexy NEC

N092 - One stage orchidopexy NEC

• Patients aged 19 years old and under at the start of their admission

Data Source

SUS - CDS

Time frame

Discharge for the index one stage inguinal orchidopexy must have occurred between April 2008 and March 2009.

Statistical methods used

Crude rate expressed as a percentage

Umbilical Hernia - % children under 2 years

Metric

The percentage of children with Umbilical Hernia, under 2 years old.

Numerator

• Umbilical Hernia: OPCS code T24 and T97
• Patients aged under 2 years old at the start of their admission

Denominator

• Umbilical Hernia: OPCS code T24 and T97
• Patients aged 19 years old and under at the start of their admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Your feedback

Please share any concerns or suggestions for improvement that you might have regarding this indicator. In particular, please consider these questions:

• Are there any diagnosis or procedure codes that have been included that you believe should be removed? Please give your reasons
• Are there any diagnosis or procedure codes that have been omitted that you believe should be included? Please give your reasons
• What are the strengths and weaknesses of this metric as an indicator

You can use the feedback box below to submit comments to HSJ. Alternatively, you can email Dr Foster directly at HGconsult2010@drfoster.co.uk. Please submit your response by 31 August 2010.