Hospital characteristics affect outcomes for common pediatric surgical conditions.
ABSTRACT Appendicitis, hypertrophic pyloric stenosis (HPS), and intussusception are common conditions treated in most hospitals. In which hospital settings are children with these conditions treated? Are there differences in outcomes based on hospital characteristics? Our purpose was to use a nationwide database to address these questions. Data were extracted from Kids' Inpatient Database 2000. Data were queried by International Classification of Diseases procedure code for appendectomy and pyloromyotomy and by diagnosis code for intussusception. Length of stay (LOS) and hospital charges were analyzed based on hospital size, location, teaching status, and specialty designation. There were 73,618 appendectomies, with 5,910 (8%) in children's hospitals. Overall LOS was 3.1 days, and was the longest in children's hospitals (3.9). Overall charges were dollar 10,562, with the highest in children's hospitals (dollar 14,124). There were 11,070 pyloromyotomies, with 2,960 (27%) in children's hospitals. Overall LOS was 2.7 days, the shortest being in children's hospitals (2.5). Overall charges were dollar 7,938, with the highest in children's hospitals (dollar 8,676). There were 2,677 intussusceptions, with 921 (34%) in children's hospitals. Overall LOS was 3.0 days, the shortest being in children's hospitals (2.8). Overall charges were dollar 9,558, with the highest in children's hospitals (dollar 10,844). Most children with appendicitis, HPS, and intussusception are treated in nonspecialty hospitals. HPS (27%) and intussusception (34%) are more likely than appendicitis (8%) to be treated in children's hospitals. Children's hospitals have higher charges for all three conditions despite shorter LOS for HPS and intussusception.
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ABSTRACT: The United States’ healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved has unfortunately become divisive. Our goal, therefore, is 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.Journal of Pediatric Surgery 05/2014; DOI:10.1016/j.jpedsurg.2014.02.085 · 1.31 Impact Factor
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ABSTRACT: To examine the differences in short-term outcomes and laparoscopic cholecystectomy rates between children's hospitals and non-children's hospitals for uncomplicated pediatric gallbladder disease. A retrospective study was performed of cholecystectomy patients aged 4 to 12 years in 2003 from the Kid's In-Patient Database. Patients with significant comorbidities were excluded. We compared length of hospitalization, complication rates, and laparoscopic cholecystectomy utilization between hospital types. Five-hundred fifty-six cholecystectomies were performed for children aged 4 to 12 years in 2003 after exclusion. Children's hospital patients had longer hospitalizations (3.34 versus 2.52 days, P < 0.001), and more complications (3.4 versus 0.9%, P = 0.05) despite fewer emergency admissions. Utilization of laparoscopic cholecystectomy was lower at children's hospitals (91 versus 97% P < 0.005). After excluding sickle cell patients, children's hospitals patients still had lower laparoscopic cholecystectomy rates (89 versus 97%, P < 0.005) and longer hospitalizations (3.12 versus 2.44 days, P < 0.01). Hospital and surgeon volumes were not associated with better outcomes. Factors associated with longer hospitalization included treatment at children's hospitals, nonelective admission, sickle cell disease, and complications (P < 0.001). Children without significant comorbidities have longer hospitalizations when treated at children's hospitals for cholecystectomies compared with those at non-children's hospitals. Laparoscopic cholecystectomy use was lower at children's hospitals and similar differences in outcomes remained when comparing only laparoscopic cholecystectomy patients.Journal of Surgical Research 04/2008; 153(2):195-200. DOI:10.1016/j.jss.2008.03.031 · 2.12 Impact Factor
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ABSTRACT: To determine the resource utilization and national variation in the management of pediatric retropharyngeal abscesses. The Kids' Inpatient Database (KID) 2003 was analyzed. International Classification of Diseases, Ninth Revision code 478.24 was the inclusion criteria. One thousand three hundred and twenty-one admissions with retropharyngeal abscess were sampled from the KID in 2003; there were no deaths. The mean age of patients was 5.1 years (S.D. 4.4 years); 63% were male. Of all admissions, 563 (43%) patients underwent surgical drainage of their infection; surgical patients had longer length of stays and total charges than patients managed medically. The average state spending per admission varied from $5126 (Utah) to $27,776 (California). There was seasonal variation in admissions with the highest percentage of admissions occurring in March (10.7%) and lowest in August (3.8%). Indicators of increased resource utilization included age (older patients), increased length of stay, non-elective admission, discharge quarter, and number of other diagnoses on record. There is a statistically significant decrease in the length of stay and total charges in patients admitted in the Midwest compared to other regions of the country. This study demonstrates national demographics and normative data on a commonly treated pediatric disease process, retropharyngeal space infections. The average demographic of such a patient is a 5-year-old male from an urban location admitted in a non-elective fashion via the emergency department. The mean total charges were $16,377; 90% of admissions had total charges less than $28,511. Patients who underwent surgical procedures had mean total charges of $22,013. There exists significant national variation in resource utilization for this commonly treated disease process.International Journal of Pediatric Otorhinolaryngology 11/2008; 72(12):1837-43. DOI:10.1016/j.ijporl.2008.09.001 · 1.32 Impact Factor