Specialist Neonatal and Paediatric Surgery clinical outcomes

Clinical outcomes are measurable changes in health, function or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.

About the Specialist Neonatal and Paediatric Surgery service

The Specialist Neonatal and Paediatric Surgery (SNAPS) service at Great Ormond Street Hospital (GOSH) provides specialist surgical treatment for newborn babies and children with congenital (present at birth) conditions as well as diseases of the gastrointestinal tract and other abdominal problems including solid tumours.

The department has an excellent international reputation and continues to develop new ways of treating newborn babies and children, such as oesophageal replacement surgery and minimally invasive (keyhole) surgery.

The SNAPS department works closely with a number of other departments within GOSH, including Urology, ENT, Interventional Radiology, Gastroenterology and Oncology.

Referrals are made in most cases via local hospital consultants, community paediatricians or in exceptional circumstances via a GP.

Clinical outcome measures

1. Non-elective re-admission rate within 30 days to any specialty after a procedure under SNAPS

Complications resulting from surgery can occasionally cause patients to be readmitted to hospital. The rate of readmissions is a standard hospital outcome that is monitored to reduce complications and improve care. The table below shows the number of patients discharged from SNAPS who have a non-elective (emergency) readmission within 30 days of discharge (excludes day cases).

Numerator:number of inpatient discharges under SNAPS that have a subsequent non-elective readmission within 30 days of discharge from GOSH.

Denominator: number of all inpatient discharges from GOSH under SNAPS. Day cases are excluded.

Table 1 Non-elective re-admission rate within 30 days to any specialty after a procedure under SNAPS

Year Patients requiring non-elective readmission within 30 days Total number of all inpatients discharged under SNAPS Percentage of readmissions within 30 days
2012/13 51 1,273 4.0%
2013/14 50 1,309 3.8%
2014/15 30 1,130 2.7%
2015/16 40 1,064 3.8%
2016/17 45 1,074 4.2%
2017/18 40 1,057 3.8%
Total 256 6,907 3.7%

2. Unscheduled return to theatre within seven days under any specialty after a procedure under SNAPS

Due to the complexity of some operations or related to complications during surgery, a small number of patients may need further surgery that was unplanned. To help reduce this occurrence and its potential effects on outcome and patient experience, we monitor the rate of patients who return to theatre soon after a procedure. The table below shows the number of patients who have an unscheduled return to theatre within seven days of previous scheduled surgery under SNAPS.

Numerator: number of unscheduled theatres cases (any specialty) within seven days of previous scheduled theatre case under SNAPS.

Denominator: number of scheduled theatres cases under SNAPS.

Table 2 Unscheduled return to theatre within seven days under any specialty after a procedure under SNAPS

Year Patients returning unscheduled to theatre within 7 days  Total number of scheduled theatre cases under SNAPS Percentage of patients returning unscheduled to theatre within 7 days
2012/13 28 1,210 2.3%
2013/14 20 1,248 1.6%
2014/15 21 1,175 1.8%
2015/16 16 1,154 1.4%
2016/17 9 1,196 0.8%
2017/18 14 1,203 1.2%
Total 108 7,186 1.5%

 

3. Inguinal hernia repair procedure

An inguinal hernia happens at the inguinal canal, a narrow passage at the base of the abdomen that usually closes shortly before a child is born. If it remains open, the contents of the abdomen can push down towards the groin. Inguinal hernias are treated with surgery as occasionally they cause serious complications. For a small number of patients a hernia can reoccur, and re-do surgery is needed.

The table below shows the number patients who had a re-do inguinal hernia repair, due to a recurring hernia, within two years of the original surgery (excludes patients whose original surgery was not done at GOSH). Numbers are shown separately for laparoscopic and open surgery. Laparoscopic (keyhole) surgery offers specific advantages, particularly in children aged under one, and when hernias are present on both sides of the groin. Based on published research, the rate of recurrence of inguinal hernia after surgery in infants is expected to be around two to four per cent.

Numerator: number of re-do inguinal hernia repairs within two years of primary procedure at GOSH.

Denominator: number of inguinal hernia primary repairs at GOSH. Procedures done at other centres are excluded.

Table 3 Inguinal hernia repair procedure

Open or laparoscopic repair Year Patients having re-do inguinal hernia repair within 2 years Total number of inguinal hernia primary repairs Percentage of patients having re-do inguinal hernia repair within 2 years
Laparoscopic 2012/13 2 142 1.4%
2013/14 0 108 0.0%
2014/15 1 109 0.9%
2015/16 3 119 2.5%
2016/17 1 114 0.9%
2017/18 1 105 1.0%
Total 8 697 1.1%
Open 2012/13 1 70 1.4%
2013/14 2 105 1.9%
2014/15 0 80 0.0%
2015/16 2 92 2.2%
2016/17 0 84 0.0%
2017/18 2 68 2.9%
Total 7 499 1.4%

This information was published in July 2018 and will be updated annually.

References

Esposito, C. et al. Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review. Journal of Laparoendoscopic & Advanced Surgical Techniques, 24, 811-818 (2014)

Choi W, et al. Outcomes following laparoscopic inguinal hernia repair in infants compared with older children. Pediatric Surgery International 2012 Dec 28(12):1165-9.

Rooney A, et al. Laparoscopic Inguinal Hernia Repair; A Review of 5 years of Practice British Association of Paediatric Surgeons (BAPS), Liverpool UK, July 2018