Using NSQIP-P to Identify Areas of Greatest Opportunity for Quality Improvement in Pediatric Otolaryngology.

National pediatric otolaryngology practice patterns can highlight high-yield opportunities for quality improvement. Our objective was to identify procedures with the greatest potential impact for targeted quality initiatives using the ACS National Surgical Quality Improvement Program-Pediatric (NSQIP-P). Using the 2021-2023 NSQIP-P Participant Use Files, we identified all Current Procedural Terminology (CPT Codes) submitted under otolaryngology and pediatric otolaryngology with more than five annual cases. Procedures were grouped by type, and a Pareto analysis was used to determine high-volume targets. Across 2021-2023, 52,490 cases representing 91 CPT codes met inclusion criteria. Seven procedures accounted for 80% of case volume, including tympanoplasty with or without mastoidectomy (22.1%), airway endoscopy (19.1%), cochlear implantation (10%), endoscopic sinus surgery (10%), congenital neck cyst resection (8.8%), and palatoplasty (6.5%). Pediatric otolaryngology practice is highly concentrated in a small number of procedures. Focusing quality improvement efforts on these high-volume surgeries may yield the greatest impact on reducing variation and optimizing outcomes.