CSOR –Children’s Surgery Outcome Reporting

C-SOR is the Children’s Surgery Outcome Reporting programme and is a seven year, £3 million NIHR funded programme of work which provides a unique opportunity to learn more about how we can improve the health and wellbeing of children treated in the UK for a range of complex surgical conditions. It is a collaboration of investigators across ten hospitals and led from the National Perinatal Epidemiology Unit at the University of Oxford under the auspices of Prof. Marian Knight (Oxford) and Prof. Simon Kenny Liverpool). It follows on from the successful and now defunct BAPS-CASS series.

The current face of CSOR is Mr Ben Allin (Academic Clinical Lecturer) [email protected] ]

Aims

To investigate whether it is possible to reduce unwarranted variation in the health and wellbeing of children undergoing early surgery at different hospitals in England And Scotland.

There are a variety of on-going workstreams within this project. The initial stage of the programme developed a research database containing the information necessary to understand how successfully children are being treated for six complex surgical conditions. This database combines information collected directly from hospitals’ Electronic Patient Record systems with information collected from NHS England and information collected directly from parents. All information is collected during routine care without the need for staff to complete additional data collection forms. The database is now live in seven hospitals and has already collected information on over 200 infants. In the long-term, this database will provide a valuable resource that researchers can use to conduct studies that improve the health and wellbeing of children with complex surgical conditions.

The second stage of the programme involves working with hospitals to identify ways in which they can improve the health and wellbeing of children they treat. Data from the CSOR research database will inform a process of appreciative inquiry, in which hospital teams work with researchers, external clinicians and other stakeholders as necessary to identify strengths on which the hospital can build as well as opportunities for development. This will be a positive learning process, not an inspection, a critical appraisal or an extended morbidity and mortality review. These appreciative inquiry processes will begin in mid-2025, and once complete, appropriate data will be made publicly available through a web-based dashboard.

In the last six months of the programme, a process evaluation will be undertaken to understand how well the system works. Based on this evaluation, decisions will be taken on expanding the database to cover additional conditions or opening participation to additional hospitals. This evaluation is expected to be completed in October 2026.

Publications

The early work has been presented in 2023 in both BAPS [Investigating the clinical plausibility of the Children’s Surgery Outcome Reporting Programme (CSOR) Treatment Success Score (TSS) in an existing cohort of 1383 infants with surgical conditions]

and EUPSA [What constitutes successful treatment for children with a surgical condition? a discrete choice experiment to understand stakeholder’s preferences and then published in the Archives of Disease in Childhood. This described how treatment success will be defined (1) and why the team believe it is important to include patients and parents in deciding what successful treatment looks like (2).