Report of 2,087,915 surgical admissions in U.S. children: inpatient mortality rates by procedure and specialty.

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.