Health OutcomeHealth outcomes and the healthcare and societal cost of optimizing pediatric surgical care in the United States☆
Section snippets
Data sources
The 2011 state-specific Healthcare Cost and Utilization Project (HCUP) family of databases for Florida, Iowa, Nebraska, New York, Utah, and Vermont was used to identify all children less than 18 years of age who had complex inpatient surgical procedures [13], [14]. These six states were chosen to estimate the potential impact of this optimization effort on varied geographic and demographic regions in the U.S. The 2011 data were the most recent source for inpatient and emergency department (ED)
Provision of care
There were 8006 children treated for selected conditions judged to require the resources of an ACS Level I center. Among those children, 54.6% received their care outside of a Level I center: 2391(30%) received care at a Level II center and 2005 (24.6%) at a Level III center (Table 1). Nearly half (n = 3820, 47.7%) of all children treated were less than one year of age, and 55.3% (n = 2093) of these infants were treated outside of a Level I center. Children treated at Level I centers were more
Discussion
This study offers a unique medical and social perspective on the potential impact of the ACS-CSV verification program on healthcare outcomes and the cost of children’s surgical care in the United States. Our findings suggest that half of surgically complex children with needs meriting care at a Level I center are currently treated at Level II or III centers. Our data further suggest that treating children in this cohort in the optimized scenario at Level I centers would not significantly
Conclusion
This study demonstrates that many complex children’s surgical procedures are currently performed at hospitals with limited pediatric resources. Our study did not identify measurable differences in healthcare outcomes, healthcare costs, or societal costs between centers, although, over time, with additional data evaluating the CSV process, these findings may change. These data suggest that optimizing families to a Level I center instead of the Level II or III center where they are currently
Acknowledgments
The authors would like to acknowledge the participating investigators, Arianna Delsman, BA and Tony Escobar, MD for their time, hard work, and dedication to this project.
References (44)
- et al.
Ramifications of the children’s surgery verification program for patients and hospitals
J Am Coll Surg
(2018) - et al.
Hospital transfers and patterns of mortality in very low birth weight neonates with surgical necrotizing enterocolitis
J Pediatr Surg
(2016) - et al.
Should paediatric intensive care be centralised? Trent versus Victoria
Lancet
(1997) - et al.
The effect of level of care on gastroschisis outcomes
J Pediatr
(2017) - et al.
Appendicitis in children treated by pediatric versus general surgeons
j am coll surg
(2007) - et al.
Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy
J Pediatr Surg
(2015) - et al.
Effect of subspecialty training and volume on outcome after pediatric inguinal hernia repair
J Pediatr Surg
(2005) - et al.
Generalized modeling approaches to risk adjustment of skewed outcomes data
J Health Econ
(2005) - et al.
Inferior outcomes on the waiting list in low-volume pediatric heart transplant centers
Am J Transplant
(2017) - et al.
A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes
J Pediatr Surg
(2005)
Differences in outcome with subspecialty care: pyloromyotomy in North Carolina
J Pediatr Surg
Does hospital type affect pyloromyotomy outcomes? Analysis of the Kids’ Inpatient Database
Surgery
Effect of subspecialty training on outcome after pediatric appendectomy
J Pediatr Surg
American College of Surgeons optimal resources for children’s surgical care
Time to get on the bus: children’s surgery and where we need to go
Pediatrics
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis
JAMA Pediatr
Frequency and variety of inpatient pediatric surgical procedures in the United States
Pediatrics
Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery: a systematic review
JAMA Pediatr
U.S. Department of Health & Human Services Agency for Healthcare Research and Quality: Healthcare Cost and Utilization Project (HCUP). State Inpatient Database
U.S. Department of Health & Human Services Agency for Healthcare Research and Quality: Healthcare Cost and Utilization Project (HCUP). State Emergency Department Database
AHA annual survey database
CDC levels of care assessment tool (CDC LOCATe)
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Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis
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- ☆
Funding: This work was supported by a grant from the Children’s Hospital Association to Dr. Goldin. Dr. Flynn-O’Brien received fellowship support from the National Institute of Child Health and Human Development [grant number T32-HD057822]. The content, findings and conclusions in this report are solely the responsibility of the authors and do not necessarily represent the official views or position of the National Institutes of Health or the Children’s Hospital Association.
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