Erik D Skarsgard

MD, MSc

Investigator, BC Children's Hospital
Surgeon in Chief, Department of Pediatric Surgery, BC Children’s Hospital

A major focus of my research is the short and long term functional outcomes following neonatal treatment of structural birth defects. Study of these rare and complex birth defects has been facilitated by the Canadian Pediatric Surgery Network (CAPSNET) and Data Registry. Founded in 2006 with CIHR operating grant support, and maintained continuously since with CIHR funding, CAPSNet has enabed the publication of >40 peer reviewed manuscripts. Recent knowledge translation efforts of the Network have focused on practice standardization for gastroschisis and congenital diaphragmatic hernia using available best practice evidence. CAPSNet’s Annual Report provides benchmarked, risk-adjusted outcomes data for each of its 17 participant centres, which are used to guide site-based targeted practice improvement.

The recently completed Secondary Analysis of Databases project combined CAPSNet data with vital statistics data (Stats Canada) to make first time observations of the epidemiology of gastroschisis in Canada, including maternal, environmental and sociodemographic risk factors. Using spatial mapping techniques, we have made observations of significant geographic variation in the incidence of gastroschisis, which points to other possible mechanisms of environmental causation requiring further study.

Surgical Quality and Safety: One of our greatest opportunities for surgical outcome improvement lies in the use of high quality patient level data to recognize and enable surgical outcome variation as a driver of continuous quality improvement. BC Children’s Hospital is currently the only Canadian Children’s Hospital participant in the American College of Surgeons (ACS) pediatric National Surgical Quality Improvement Program (NSQIP). By collecting case data on selected surgical procedures, and through analysis of our risk-adjusted “performance” against the other 50 odd US children’s hospitals, we gain an awareness of where we have the greatest opportunities for outcome improvement. Using published evidence, and by analyzing our own risk predictors for occurrences, we can use the tools of implementation science to modify our processes and continually improve our surgical outcomes.