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Hospital characteristics affect outcomes for common pediatric surgical conditions
Graham H Cosper1, Mary Sue Hamann, Anquonette Stiles
1New Hanover Regional Medical Center, Coastal Area Health Education Center, Wilmington, North Carolina 28402-9025, USA.
Insights
Most children with appendicitis, hypertrophic pyloric stenosis (HPS), and intussusception are treated in general hospitals. Children's hospitals had higher charges for these conditions, despite shorter lengths of stay for HPS and intussusception.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Hospital Administration
Background:
- Appendicitis, hypertrophic pyloric stenosis (HPS), and intussusception are common pediatric surgical emergencies.
- Understanding treatment settings and associated costs is crucial for healthcare planning.
Purpose of the Study:
- To investigate hospital settings for pediatric appendicitis, HPS, and intussusception treatment.
- To analyze differences in outcomes (length of stay, charges) based on hospital characteristics.
Main Methods:
- Utilized the Kids' Inpatient Database 2000 for nationwide analysis.
- Extracted data using ICD procedure codes for appendectomy/pyloromyotomy and diagnosis codes for intussusception.
- Analyzed length of stay and hospital charges stratified by hospital size, location, teaching status, and specialty.
Main Results:
- Most children with these conditions are treated in non-specialty hospitals.
- Children's hospitals treated a higher proportion of HPS (27%) and intussusception (34%) cases compared to appendicitis (8%).
- Children's hospitals incurred higher charges for all three conditions, with shorter lengths of stay for HPS and intussusception.
Conclusions:
- Nonspecialty hospitals are the primary treatment centers for these common pediatric conditions.
- Children's hospitals, while treating a significant portion of HPS and intussusception, are associated with higher healthcare costs.
- Further research into cost-effectiveness and outcome variations across different hospital types is warranted.
Abstract:
Appendicitis, hypertrophic pyloric stenosis (HPS), and intussusception are common conditions treated in most hospitals. In which hospital settings are children with these conditions treated? Are there differences in outcomes based on hospital characteristics? Our purpose was to use a nationwide database to address these questions. Data were extracted from Kids' Inpatient Database 2000. Data were queried by International Classification of Diseases procedure code for appendectomy and pyloromyotomy and by diagnosis code for intussusception. Length of stay (LOS) and hospital charges were analyzed based on hospital size, location, teaching status, and specialty designation. There were 73,618 appendectomies, with 5,910 (8%) in children's hospitals. Overall LOS was 3.1 days, and was the longest in children's hospitals (3.9). Overall charges were dollar 10,562, with the highest in children's hospitals (dollar 14,124). There were 11,070 pyloromyotomies, with 2,960 (27%) in children's hospitals. Overall LOS was 2.7 days, the shortest being in children's hospitals (2.5). Overall charges were dollar 7,938, with the highest in children's hospitals (dollar 8,676). There were 2,677 intussusceptions, with 921 (34%) in children's hospitals. Overall LOS was 3.0 days, the shortest being in children's hospitals (2.8). Overall charges were dollar 9,558, with the highest in children's hospitals (dollar 10,844). Most children with appendicitis, HPS, and intussusception are treated in nonspecialty hospitals. HPS (27%) and intussusception (34%) are more likely than appendicitis (8%) to be treated in children's hospitals. Children's hospitals have higher charges for all three conditions despite shorter LOS for HPS and intussusception.
