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Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy. J Pediatr Surg 2015 Sep;50(9):1549-55 PMID: 25962842

Pubmed ID

25962842

DOI

10.1016/j.jpedsurg.2015.03.063

Abstract

BACKGROUND: The effects of hospital location and designation on postoperative pediatric outcomes remain unclear. We hypothesized that urban hospital outcomes would be superior to rural hospitals, and that outcomes at urban centers would differ for children from rural versus urban counties.

METHODS: Retrospective cohort study of children undergoing appendectomy (n=129,507) and pyloromyotomy (n=13,452) using the 2006/2009 KID databases. Hospitals were characterized by specialty designation and classified as urban/rural. County of residence was classified as urban/rural. Outcomes included complications and length of stay. Multivariate regression models were used to adjust for confounding.

RESULTS: Among appendectomy patients, treatment at urban hospitals was associated with reduced odds of any postoperative complication (OR=0.77, 95% C.I. 0.70-0.85) and anesthesia-related complications (OR=0.72, 95% C.I. 0.57-0.91). This association was strongest in the youngest children (<5 years) and at children's hospitals. For pyloromyotomy patients, urban hospitals were associated with reduced odds of any complication (OR=0.43, 95% C.I. 0.24-0.75), anesthesia-related complications (OR=0.14, 95% C.I. 0.05-0.37), and duodenal perforation (OR=0.46, 95% C.I. 0.19-1.07). These associations were most significant at children's hospitals.

CONCLUSIONS: Postoperative outcomes appear to be improved at urban specialty hospitals relative to rural hospitals for certain common pediatric procedures. Identification of the factors driving this association may help inform resource optimization efforts in pediatric surgery.

Author List

McAteer JP, Richards MK, Stergachis A, Abdullah F, Rangel SJ, Oldham KT, Goldin AB

Author

Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84942550924   12 Citations

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

Appendectomy
Appendicitis
Child
Child, Preschool
Female
Follow-Up Studies
Hospitals, Pediatric
Hospitals, Rural
Hospitals, Urban
Humans
Incidence
Infant
Infant, Newborn
Male
Postoperative Complications
Postoperative Period
Pyloric Stenosis
Pylorus
Retrospective Studies
United States
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad