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Pediatr Surg Int. 2019 Aug 1. doi: 10.1007/s00383-019-04525-x. [Epub ahead of print]

Neonatal surgery in low- vs. high-volume institutions: a KID inpatient database outcomes and cost study after repair of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis.

Author information

1
Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA.
2
Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
3
Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA. niti.shahi@childrenscolorado.org.
4
Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. niti.shahi@childrenscolorado.org.
5
Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA.

Abstract

BACKGROUND/PURPOSE:

The volume-outcome relationship and optimal surgical volumes for repair of congenital anomalies in neonates is unknown.

METHODS:

A retrospective study of infants who underwent diaphragmatic hernia (CDH), gastroschisis (GS), and esophageal atresia/tracheoesophageal fistula (EA/TEF) repair at US hospitals using the Kids' Inpatient Database 2009-2012. Distribution of institutional volumes was calculated. Multi-level logistic/linear regressions were used to determine the association between volume and mortality, length of stay, and costs.

RESULTS:

Total surgical volumes were 1186 for CDH, 1280 for EA/TEF, and 3372 for GS. Median case volume per institution was three for CDH and EA/TEF, and four for GS. Hospitals with annual case volumes ≥ 75th percentile were considered high volume. Approximately, half of all surgeries were performed at low-volume hospitals. No clinically meaningful association between volume and outcomes was found for any procedure. Median cost was greater at high- vs. low-volume hospitals [CDH: $165,964 (p < 0.0001) vs. $104,107, EA/TEF: $85,791 vs. $67,487 (p < 0.006), GS: $83,156 vs. $72,710 (p < 0.0009)].

CONCLUSIONS:

An association between volume and outcome was not identified in this study using robust outcome measures. The cost of care was higher in high-volume institutions compared to low-volume institutions.

LEVEL OF EVIDENCE:

III.

KEYWORDS:

Congenital anomalies; Hospital variation; KID Database; Neonatal surgery; Surgical outcomes; Surgical volume

PMID:
31372730
DOI:
10.1007/s00383-019-04525-x

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