Faculty Collaboration Database

Outcomes in pediatric surgery by hospital volume: a population-based comparison. Pediatr Surg Int 2013 Jun;29(6):561-70

Date

03/16/2013

Pubmed ID

23494672

DOI

10.1007/s00383-013-3293-9

Scopus ID

2-s2.0-84878593257 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

PURPOSE: The volume-outcome relationship has not been well-defined in pediatric surgery. Our aim was to determine the association between hospital-volume and outcomes for common procedures in children.

METHODS: Retrospective population-based cohort study of patients <18 years of age hospitalized between 1989 and 2009 for common surgical procedures in Washington State. The association between annual hospital case volume and post-operative outcomes (readmission and reoperation within 30-days, post-operative complications) was assessed using multivariate logistic regression.

RESULTS: The three most common procedures over the study period were appendectomy (n = 36,525), skin and soft tissue debridement (n = 9,813), and pyloromyotomy (n = 3,323). A greater proportion of patients with comorbidities were treated at higher-volume hospitals. After adjustment, outcomes did not differ significantly across hospital-volume quartiles except that debridement patients had lower odds of readmission (OR = 0.63, 95 % CI 0.46-0.88) and re-operation (OR = 0.53, 95 % CI 0.35-0.81) at medium-high-volume compared with high-volume centers.

CONCLUSIONS: This work suggests that risks of readmission and post-operative complications for common procedures may be similar across hospital-volume categories, but appropriate risk-stratification is essential. In order to optimize safety, we must identify the resources required for low-, medium-, and high-risk surgical patients, and implement these standards into practice.

Author List

LaRiviere CA, McAteer JP, Huaco JA, Garrison MM, Avansino JR, Koepsell TD, Oldham KT, Goldin AB

MESH terms used to index this publication - Major topics in bold

Adolescent
Appendectomy
Child
Child, Preschool
Debridement
Female
Hospitalization
Hospitals, Pediatric
Humans
Incidence
Infant
Infant, Newborn
Male
Postoperative Complications
Postoperative Period
Retrospective Studies
United States