Stig Sømme1,2, Niti Shahi3,4, Lisa McLeod1, Michelle Torok5, Beth McManus5, Moritz M Ziegler1,2. 1. Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA. 2. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. 3. Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, 80045, USA. niti.shahi@childrenscolorado.org. 4. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. niti.shahi@childrenscolorado.org. 5. Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA.
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.
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.
Authors: Jeffrey P Jacobs; John E Mayer; Constantine Mavroudis; Sean M O'Brien; Erle H Austin; Sara K Pasquali; Kevin D Hill; David M Overman; James D St Louis; Tara Karamlou; Christian Pizarro; Jennifer C Hirsch-Romano; Donna McDonald; Jane M Han; Susan Becker; Christo I Tchervenkov; Francois Lacour-Gayet; Carl L Backer; Charles D Fraser; James S Tweddell; Martin J Elliott; Hal Walters; Richard A Jonas; Richard L Prager; David M Shahian; Marshall L Jacobs Journal: Ann Thorac Surg Date: 2017-03 Impact factor: 4.330
Authors: Jarod P McAteer; Cabrini A LaRiviere; George T Drugas; Fizan Abdullah; Keith T Oldham; Adam B Goldin Journal: JAMA Pediatr Date: 2013-05 Impact factor: 16.193
Authors: Stine Kjaer Urhoj; Joachim Tan; Joan K Morris; Joanne Given; Gianni Astolfi; Silvia Baldacci; Ingeborg Barisic; Joanna Brigden; Clara Cavero-Carbonell; Hannah Evans; Mika Gissler; Anna Heino; Sue Jordan; Renée Lutke; Ljubica Odak; Aurora Puccini; Michele Santoro; Ieuan Scanlon; Hermien E K de Walle; Diana Wellesley; Óscar Zurriaga; Maria Loane; Ester Garne Journal: PLoS One Date: 2022-07-22 Impact factor: 3.752