Variations between hospitals in antireflux procedures in children

To examine the differences and trends in pediatric antireflux procedures (ARPs) across individual pediatric hospitals over time.

Retrospective cohort study.

Administrative database containing inpatient records with discharge dates between January 1, 2001, and March 31, 2006.

Hospitalized pediatric patients younger than 18 years with primary procedure codes for ARP, appendectomy, pyloromyotomy, and gastrostomy tube placement. The comparisons with admissions for these common procedures were used to identify changes in the incidence of ARP per hospital per year.

The ratio of ARPs to appendectomies, pyloromyotomies, gastrostomies, and all 3 procedures combined, in each hospital by year.

During our study period 13 691 ARPs, 41 441 nonincidental appendectomies, 14 895 pyloromyotomies, and 23 527 gastrostomy tube placements were identified. The average number of ARPs per appendectomy, pyloromyotomy, and gastrostomy tube placement declined annually across free-standing pediatric institutions. When these annual changes are examined within each hospital individually, however, it appears that such changes are not occurring equally, in that some hospitals are performing significantly greater and some significantly fewer ARPs relative to these common procedures.

The number of ARPs being performed in 36 free-standing children's hospitals is decreasing each year relative to several operations commonly performed at these institutions. Despite this overall annual decrease, there is tremendous variation between individual hospitals in how frequently ARPs are being performed relative to these procedures.