Genia Dubrovsky1, Greg D Sacks1, Scott Friedlander2, Steven Lee3. 1. Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA. 2. Department of Pediatrics, Harbor-UCLA, Torrance, California, USA. 3. Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; Department of Pediatrics, Harbor-UCLA, Torrance, California, USA; Division of Pediatric Surgery, Department of Surgery, Harbor-UCLA, Torrance, California, USA. Electronic address: slleemd@yahoo.com.
Abstract
BACKGROUND: For many surgical operations, there is a well-established relationship between surgical volume and outcome. We investigated whether this relationship exists for infants with gastroschisis. METHODS: Using the Kids' Inpatient Database for years 2003, 2006, 2009, and 2012, we identified all patients undergoing gastroschisis repair. Controlling for patient characteristics and complexity of disease (comorbid intestinal atresia/perforation, necrotizing enterocolitis, and respiratory distress syndrome), we compared surgical outcomes (mortality, length of stay, and incidence of TPN cholestasis) by hospital volume based on quartile for gastroschisis cases treated per year. RESULTS: We identified 7769 patients treated at 743 hospitals. The majority of hospitals were low-volume (n=445), while only 49 were high-volume. The overall mortality rate was 4.3%, and the median length of stay was 34days. Adjusting for clinical and demographic characteristics, patients treated at high-volume hospitals had similar rates of TPN cholestasis and similar mortality rates, but a higher chance for a prolonged length of stay compared to those treated at low-volume hospitals. CONCLUSIONS: Using national data, we found that gastroschisis patients treated at high-volume hospitals did not have improved outcomes. The benefits of high-volume hospitals, which seem to be important for complex pediatric surgery, may not apply to treatment of gastroschisis. LEVEL OF EVIDENCE: Level III Retrospective Study.
BACKGROUND: For many surgical operations, there is a well-established relationship between surgical volume and outcome. We investigated whether this relationship exists for infants with gastroschisis. METHODS: Using the Kids' Inpatient Database for years 2003, 2006, 2009, and 2012, we identified all patients undergoing gastroschisis repair. Controlling for patient characteristics and complexity of disease (comorbid intestinal atresia/perforation, necrotizing enterocolitis, and respiratory distress syndrome), we compared surgical outcomes (mortality, length of stay, and incidence of TPN cholestasis) by hospital volume based on quartile for gastroschisis cases treated per year. RESULTS: We identified 7769 patients treated at 743 hospitals. The majority of hospitals were low-volume (n=445), while only 49 were high-volume. The overall mortality rate was 4.3%, and the median length of stay was 34days. Adjusting for clinical and demographic characteristics, patients treated at high-volume hospitals had similar rates of TPN cholestasis and similar mortality rates, but a higher chance for a prolonged length of stay compared to those treated at low-volume hospitals. CONCLUSIONS: Using national data, we found that gastroschisispatients treated at high-volume hospitals did not have improved outcomes. The benefits of high-volume hospitals, which seem to be important for complex pediatric surgery, may not apply to treatment of gastroschisis. LEVEL OF EVIDENCE: Level III Retrospective Study.
Authors: Katherine T Flynn-O'Brien; Morgan K Richards; Davene R Wright; Frederick P Rivara; Wren Haaland; Leah Thompson; Keith Oldham; Adam Goldin Journal: J Pediatr Surg Date: 2018-11-28 Impact factor: 2.545
Authors: Asta Tauriainen; Anna Hyvärinen; Arimatias Raitio; Ulla Sankilampi; Mikko Gärding; Tuomas Tauriainen; Ilkka Helenius; Kari Vanamo Journal: Pediatr Surg Int Date: 2021-09-05 Impact factor: 1.827
Authors: Andrea Schmedding; Boris Wittekind; Emilia Salzmann-Manrique; Rolf Schloesser; Udo Rolle Journal: Pediatr Surg Int Date: 2020-03-26 Impact factor: 1.827