Report of 2,087,915 Surgical Admissions in U. S. Children: Inpatient Mortality Rates by Procedure and Specialty
ABSTRACT Mortality rates for eight surgical procedures have been endorsed by the Agency for Healthcare Research and Quality as part of the Inpatient Quality Indicators developed to assist hospitals in identifying potential problem areas and as an indirect measure of quality for inpatient adult surgical care. Little to no broad information relating to the overall mortality relating to the surgical care of children is available. An analysis providing national data on the most common procedures performed in children and their associated mortality would be useful in beginning to create benchmarks for standards of surgical care in the pediatric patient.
A total of 93 million admissions from the National Inpatient Sample (NIS) file from the years 1988-1996, 1998, 1999, 2001, 2002, 2004-2005 and the Kids Inpatient Database (KID) from 1997, 2000, 2003 were screened to identify surgical admissions in children under the age of 18 years. Variables such as gender, race, age at admission, length of hospital stay, total hospital charges, insurance status, and inpatient mortality were analyzed. Diagnosis related group (DRG) codes were used to provide inpatient mortality rates for 147 different procedures and 15 surgical subspecialties.
Over the 18-year period considered, a total of 2,087,915 surgical admissions in U.S. children were identified. Most of the patients were white (60.92%), male (54.64%), and were treated in urban, teaching hospitals (60.36%). Overall inpatient mortality was 0.85%, with a median hospital stay of 3 days. Procedures with the highest mortality were craniotomies for trauma (26.27%), liver and/or intestinal transplants (11.12%), heart transplants (10.94%), and other procedures for multiple significant trauma (10.69%). When analyzed by surgical subspecialty, gastrointestinal or general pediatric surgery saw the highest volume of patients, followed by orthopedic and ear, nose, and throat surgery (534,053 vs. 352,228 vs. 257,118 total procedures, respectively).
Pediatric surgical literature has classically focused on disease-based outcomes. However, such data do not provide a comprehensive profile of pediatric surgical outcomes by procedure or subspecialty. The present study provides nationwide data relating to inpatient pediatric surgical outcomes in U.S. hospitals by procedure and pediatric subspecialty.
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ABSTRACT: Background/Purpose: The patterns and the factors influencing outcome of paediatric surgical admissions may be crucial to policy formulation. This study reports the pattern and the outcome of paediatric surgical admissions in a developing country. Materials & Methods: The pattern and the outcome of paediatric surgical admissions at the University of Benin Teaching Hospital between January and December 2009 were audited in a retrospective study. Results: In total, 871 children aged between one day and 16 years who accounted for 43% of paediatric surgical workload were admitted, 322 (37%) on emergency basis. Of these, only 530 (60.8%) were admitted to a paediatric surgical ward while the rest were admitted in different wards, including nonsurgical wards, due to shortage of manpower and lack of paediatric surgical facilities. Three consultant paediatric surgeons and 17 nurses (only one paediatric nurse) managed an average of 46 new admissions per month with doctor to patient and nurse to patient ratio of 1: 15 and 1:33 respectively. Shortage of bed spaces also resulted in the admission of many clean surgical cases in the same ward with septic medical cases. This increased postoperative infective complications, duration of hospitalization and mortality rate especially among 106 neonates admitted to Special Care Baby Unit compared to those in paediatric surgical ward (P<0.0001). Conclusion: The need for the provision of more paediatric surgical facilities and training of more paediatric surgical personnel to match the high paediatric surgical workload is emphasized by this audit.
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ABSTRACT: OBJECTIVE:Pediatric surgical procedures are being performed in a variety of hospitals with large differences in surgical volume. We examined the frequency and variety of inpatient pediatric surgical procedures in the United States by hospital type and geographic region using a nationally representative sample.METHODS:The 2009 Kids' Inpatient Database for patients <18 years old was used to calculate surgical frequencies by using International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) codes. We performed stratified analysis by hospital type (free-standing children's hospital, children's unit within an adult hospital, and general hospital) and geographic region (South, West, Midwest, Northeast) to compare frequencies of surgical procedures.RESULTS:A total of 216 081 procedures were projected for 2009 with the top 20 procedures accounting for >90% of cases. As many as 40% of all pediatric inpatient surgical procedures are being performed in adult general hospitals. Infrequent complex low-volume neonatal surgical procedures (pullthrough for Hirschsprung disease, surgery for malrotation, esophageal atresia repair, and diaphragmatic hernia repair) were 6.8 to 16 times more likely to occur in a children's hospital. Significant regional variation in procedure frequency rates occurred for appendectomy and cholecystectomy.CONCLUSIONS:This report is the first to characterize pediatric surgical inpatient volume in the United States. Such data may influence the distribution of pediatric surgeons, number of trainees, and training curricula for pediatric surgeons, pediatricians, general surgeons and other surgical specialists who might operate on children. In addition, it raises the question of whether complex pediatric surgical procedures should preferably be performed at dedicated high volume children's hospitals.PEDIATRICS 11/2013; 132(6). DOI:10.1542/peds.2013-1243 · 5.30 Impact Factor
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ABSTRACT: OBJECTIVE:: This study aimed to identify the 10 most frequent pediatric orthopaedic injuries requiring hospitalization in the United States, the major causes of these injuries, and their economic burden to healthcare cost. METHODS:: The 2006 Kids' Inpatient Database (KID) (age range, 0-20 years) was used to determine the 10 most frequent pediatric orthopaedic injuries requiring hospitalization. The injuries were identified by ICD-9-CM codes 800.0-999.9 and external cause of injury codes (E-codes). Discharges were weighted to produce national estimates according to average age at admission, hospital charges, and length of stay. RESULTS:: The two populations accounting for the highest total hospitalization charges ($, USD) for pediatric orthopaedic injury were young children with femur fractures (aged 11 years, 20%, $32 441/visit) and adolescents with vertebral fractures (aged 17 years, 8%, $53 992/visit). But the most common injuries requiring hospitalization were femur (aged 11 years; 20%) and humerus (aged 8 years; 18%) fractures. The most costly injuries, vertebral and pelvic injuries, were largely related to motor vehicle accidents (11.7% and 14.4%, respectively). In contrast, humerus and radius fractures had a high rate of playground related injuries (21.9% and 11.3%, respectively). None of the causes accounted for more than 25% of the total incidence for the 10 most common injuries identified in this study. CONCLUSIONS:: Identification of the patients responsible for the majority of the hospitalization charges for pediatric injuries will enable institutions to better plan their budgets on the basis of the local incidence.Journal of orthopaedic trauma 05/2013; 28(3). DOI:10.1097/BOT.0b013e318299cd20 · 1.54 Impact Factor