Hospital Volumes for Common Pediatric Specialty Operations
Open Access
- 1 January 2007
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Pediatrics & Adolescent Medicine
- Vol. 161 (1), 38-43
- https://doi.org/10.1001/archpedi.161.1.38
Abstract
Objectives To describe hospital volumes for common pediatric specialty operations, to evaluate hospital and patient characteristics associated with operations performed at a low-volume hospital, and to evaluate outcomes with hospital volume. Design Retrospective cohort using the Kids' Inpatient Database 2003. Setting Discharges from 3438 hospitals in 36 states from 2003. Participants Children aged 0 to 18 years undergoing ventriculoseptal defect surgery (n = 2301), tracheotomy (n = 2674), ventriculoperitoneal shunt placement (n = 3378), and posterior spinal fusion (n = 4002). Main Exposure Hospital volume. Main Outcome Measures In-hospital mortality and postoperative complications. Results For tracheotomy and posterior spinal fusion, at least one fourth of the hospitals performed only 1 operation for children aged 0 to 18 years in 2003. For these same operations, at least half of hospitals treated 4 or fewer cases per year. For all operations, discharges from low-volume hospitals were less likely to be from children's or teaching hospitals compared with discharges from higher-volume hospitals. For tracheotomy, children were less likely to experience postoperative complications in high-volume hospitals compared with low-volume hospitals (odds ratio, 0.48; 95% confidence interval, 0.21-1.09). Conclusions Many children undergoing common pediatric specialty operations had these procedures performed in low-volume hospitals. Low-volume hospitals were less likely to be children's or teaching hospitals. Children undergoing tracheotomy experienced higher rates of complications in low-volume hospitals. Further research is needed to identify the reasons why so many children have these operations performed in low-volume hospitals.Keywords
This publication has 14 references indexed in Scilit:
- Hospital Characteristics Associated With the Management of Pediatric Splenic InjuriesJAMA, 2005
- Craniotomy for Resection of Pediatric Brain Tumors in the United States, 1988 to 2000: Effects of Provider Caseloads and Progressive Centralization and Specialization of CareNeurosurgery, 2004
- In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of careJournal of Neurosurgery: Pediatrics, 2004
- The Effect of Hospital Volume of Pediatric Appendectomies on the Misdiagnosis of Appendicitis in ChildrenPediatrics, 2004
- Regional Availability Of High-Volume Hospitals For Major SurgeryHealth Affairs, 2004
- Regionalization of High-Risk Surgery and Implications for Patient Travel TimesJAMA, 2003
- Evidence-Based Referral Results in Significantly Reduced Mortality After Congenital Heart SurgeryPediatrics, 2003
- Volume Thresholds And Hospital Characteristics In The United StatesHealth Affairs, 2003
- Intussusception: Hospital Size and Risk of SurgeryPediatrics, 2001
- Centralization of Pediatric Heart Surgery in SwedenPediatric Cardiology, 2000