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Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis.

Ruey-Kang R Chang1, Thomas S Klitzner

  • 1Division of Cardiology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California 90509, USA. rkchang@ucla.edu

Pediatrics
|February 5, 2002
PubMed
Summary
This summary is machine-generated.

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Regionalizing pediatric cardiac surgery can reduce deaths by referring patients to high-volume hospitals. This approach, however, increases patient travel distance, necessitating further cost-benefit analysis for optimal outcomes.

Area of Science:

  • Pediatric Cardiac Surgery
  • Healthcare Policy
  • Public Health

Background:

  • High surgical case volumes are linked to improved patient outcomes in various procedures, including pediatric cardiac surgery.
  • The impact of centralizing pediatric cardiac surgery services on mortality and patient travel needs evaluation.

Purpose of the Study:

  • To simulate the effects of regionalizing pediatric cardiac surgery by reducing the number of treatment centers.
  • To assess the impact of this simulated regionalization on surgical mortality rates and patient travel distances.

Main Methods:

  • Utilized statewide hospital discharge data from California (1995-1997) for pediatric cardiac surgeries.
  • Simulated regionalization by progressively 'closing' low-volume hospitals and reassigning patients to nearest high-volume centers.

Related Experiment Videos

  • Calculated changes in in-hospital mortality and patient travel distance using multivariate logistic regression for case-mix adjustment.

    • Main Results:

    • A high surgical volume was associated with a low mortality rate (overall mortality 5.34%).
    • Referring all patients from low- and medium-volume hospitals to high-volume centers could avoid 83 deaths (mortality reduced to 4.08%).
    • This regionalization increased average patient travel distance by 12.7 miles, with an overall average of 45.4 miles.

    Conclusions:

    • Theoretical regionalization of pediatric cardiac surgery can significantly reduce surgical mortality.
    • While beneficial for reducing deaths, regionalization increases patient travel distances.
    • Further studies are required to balance the benefits of reduced mortality against increased travel costs and logistical challenges.