Assessing process measures and practice variability in pediatric esophageal button battery cases: A multi-institutional cohort study

Background: Esophageal button battery (BB) is a rare, time-sensitive pediatric emergency with potential for severe morbidity and mortality. This study uses first available esophageal BB process measure data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) to identify areas of practice variability and identify opportunities for improving care. Methods: This retrospective study analyzed NSQIP-Ped pediatric patients (0–17 years) with esophageal BB ingestion from January 2021–December 2023. Process measures assessed care timeliness, perioperative imaging, and intraoperative 0.25 % sterile acetic acid irrigation. Descriptive statistics assessed cohort and hospital level variability. A subgroup analysis evaluated the impact of repeat imaging at the receiving institution on intervention times. Results: 86 patients from 28 institutions were included. Median time from presentation to diagnosis was 31 min (interquartile range [IQR]: 23–53), diagnosis to operation 76 min (IQR: 53–87), presentation to operation 98 min (IQR: 76–119), and operation to postoperative esophagram 1.4 days (IQR: 0.8–2.8). Among referred patients, those who underwent repeat imaging had significantly longer presentation to operation times compared to those who did not (104 vs. 62 min, p = 0.013). Sterile acetic acid irrigation usage was documented in 70 % of cases, with 87 % of these cases receiving >50 mL of irrigation. Conclusion: The study highlights opportunities to reduce repeat imaging for patients referred to institutions, establish the optimal timing for postoperative esophagram, and improve documentation and utilization of sterile acetic acid irrigation. These efforts may expedite and standardize care to reduce morbidity associated with button battery ingestion.