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Hospital differences in short-term outcomes for uncomplicated pediatric patients with gallbladder disease
1Mattel Children's Hospital, University of California Los Angeles Medical Center, Los Angeles, California 90095-7098, USA.
Insights
Pediatric gallbladder disease patients treated at children's hospitals experienced longer hospital stays and higher complication rates compared to non-children's hospitals. Laparoscopic cholecystectomy rates were also lower in children's hospitals.
Area of Science:
- Pediatric Surgery
- Health Services Research
Background:
- Uncomplicated pediatric gallbladder disease requires surgical intervention, typically cholecystectomy.
- Understanding variations in care and outcomes between different hospital types is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To compare short-term outcomes and laparoscopic cholecystectomy rates for uncomplicated pediatric gallbladder disease between children's and non-children's hospitals.
Main Methods:
- Retrospective analysis of the Kid's In-Patient Database (2003) for cholecystectomy patients aged 4-12 years.
- Exclusion of patients with significant comorbidities.
- Comparison of hospitalization length, complication rates, and laparoscopic cholecystectomy utilization.
Main Results:
- Children's hospitals had longer hospitalizations (3.34 vs. 2.52 days) and higher complication rates (3.4% vs. 0.9%) than non-children's hospitals.
- Laparoscopic cholecystectomy utilization was lower at children's hospitals (91% vs. 97%).
- These disparities persisted even after excluding sickle cell patients and when analyzing only laparoscopic procedures.
Conclusions:
- Children with uncomplicated gallbladder disease experience longer hospitalizations and higher complication rates at children's hospitals compared to non-children's hospitals.
- Laparoscopic cholecystectomy rates are lower in children's hospitals.
- Further investigation into the reasons for these outcome differences is warranted.
Purpose:
To examine the differences in short-term outcomes and laparoscopic cholecystectomy rates between children's hospitals and non-children's hospitals for uncomplicated pediatric gallbladder disease.
Methods:
A retrospective study was performed of cholecystectomy patients aged 4 to 12 years in 2003 from the Kid's In-Patient Database. Patients with significant comorbidities were excluded. We compared length of hospitalization, complication rates, and laparoscopic cholecystectomy utilization between hospital types.
Results:
Five-hundred fifty-six cholecystectomies were performed for children aged 4 to 12 years in 2003 after exclusion. Children's hospital patients had longer hospitalizations (3.34 versus 2.52 days, P < 0.001), and more complications (3.4 versus 0.9%, P = 0.05) despite fewer emergency admissions. Utilization of laparoscopic cholecystectomy was lower at children's hospitals (91 versus 97% P < 0.005). After excluding sickle cell patients, children's hospitals patients still had lower laparoscopic cholecystectomy rates (89 versus 97%, P < 0.005) and longer hospitalizations (3.12 versus 2.44 days, P < 0.01). Hospital and surgeon volumes were not associated with better outcomes. Factors associated with longer hospitalization included treatment at children's hospitals, nonelective admission, sickle cell disease, and complications (P < 0.001).
Conclusion:
Children without significant comorbidities have longer hospitalizations when treated at children's hospitals for cholecystectomies compared with those at non-children's hospitals. Laparoscopic cholecystectomy use was lower at children's hospitals and similar differences in outcomes remained when comparing only laparoscopic cholecystectomy patients.
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