Faculty Collaboration Database

Health outcomes and the healthcare and societal cost of optimizing pediatric surgical care in the United States. J Pediatr Surg 2019 Apr;54(4):621-627

Date

01/02/2019

Pubmed ID

30598246

Pubmed Central ID

PMC6511280

DOI

10.1016/j.jpedsurg.2018.10.102

Scopus ID

2-s2.0-85059113810 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children's Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program.

METHODS: All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers.

RESULTS: 8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario.

CONCLUSION: Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children's surgical care in the United States.

LEVEL OF EVIDENCE: II.

Author List

Flynn-O'Brien KT, Richards MK, Wright DR, Rivara FP, Haaland W, Thompson L, Oldham K, Goldin A

Author

Katherine T. Flynn-O'Brien MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin

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

Adolescent
Child
Child, Preschool
Databases, Factual
Female
Health Care Costs
Health Resources
Hospitalization
Hospitals
Humans
Infant
Inpatients
Length of Stay
Male
Postoperative Complications
Program Evaluation
Surgical Procedures, Operative
Treatment Outcome
United States