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.

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.

journal_name

Pediatr Surg Int

authors

Sømme S,Shahi N,McLeod L,Torok M,McManus B,Ziegler MM

doi

10.1007/s00383-019-04525-x

subject

Has Abstract

pub_date

2019-11-01 00:00:00

pages

1293-1300

issue

11

eissn

0179-0358

issn

1437-9813

pii

10.1007/s00383-019-04525-x

journal_volume

35

pub_type

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