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Arch Pediatr Adolesc Med. 2007 Jan;161(1):38-43.

Hospital volumes for common pediatric specialty operations.

Author information

1
Harvard Pediatric Health Services Research Fellowship Program, Division of Infectious Diseases, Children's Hospital Boston, 1 Autumn Street, AU-522, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu

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.

PMID:
17199065
DOI:
10.1001/archpedi.161.1.38
[Indexed for MEDLINE]

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