Does hospital type affect pyloromyotomy outcomes? Analysis of the Kids' Inpatient Database
Mehul V Raval1, Mark E Cohen, Katherine A Barsness
1Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA. m-raval@md.northwestern.edu
Insights
Freestanding children's hospitals offer shorter lengths of stay and lower complication rates for infant pyloromyotomy. However, general hospitals had the lowest charges despite longer stays and higher morbidity.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Hospital Administration
Background:
- Pyloromyotomy is a frequent surgical procedure for infants.
- Hospital type may influence patient outcomes such as length of stay, cost, and complications.
Purpose of the Study:
- To investigate the impact of hospital type on length of stay, charges, and morbidity for infant pyloromyotomy.
Main Methods:
- Analysis of the Kids' Inpatients Database (2000, 2003, 2006).
- Comparison of freestanding children's hospitals (CH) with children's units in general hospitals (CUGH) and general/non-children's hospitals (GH).
Main Results:
- Freestanding children's hospitals (CH) showed significantly shorter adjusted lengths of stay (2.41 days) compared to CUGH (2.75 days) and GH (2.82 days).
- CH had the lowest unadjusted complication rates (1.2%) versus CUGH (1.6%) and GH (2.2%).
- General hospitals (GH) incurred the lowest adjusted mean charges ($10,197), while CUGH had the highest ($12,284). Charges increased significantly from 2000 to 2006.
Conclusions:
- Freestanding children's hospitals (CH) are associated with shorter lengths of stay and fewer complications for pyloromyotomy.
- General hospitals (GH), despite higher complication rates and longer stays, presented the lowest overall charges.
- Opportunities exist to optimize pyloromyotomy care, enhance quality, and reduce costs across all hospital types in the U.S.
Background:
Pyloromyotomy is a common operative procedure performed on infants. The purpose of this study was to determine if hospital type affects lengths of stay (LOS), charges, and morbidity.
Methods:
Patients undergoing pyloromyotomy were identified in the Kids' Inpatients Database from 2000, 2003, and 2006. Freestanding children's hospitals (CH) were compared with children's units within general hospitals (CUGH) and general/nonchildren's hospitals (GH).
Results:
Of the 10,969 patients, 25% received care at 30 CH, 35% received care at 94 CUGH, and 40% received care at 662 GH. Adjusted LOS were 2.41 days for CH, 2.75 days for CUGH, and 2.82 days for GH (P < .01). Adjusted mean charges were $11,160 for CH, $12,284 for CUGH, and $10,197 for GH (P = .01). CH had the lowest unadjusted complication rate at 1.2% compared with 1.6% at CUGH and 2.2% at GH (P < .01). GH were more likely to have patients with prolonged LOS (> or =4 days) compared with CH after adjusting for patient and hospital factors (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.5). After accounting for LOS, CUGH were more likely to have higher charges (> or =$11,057) compared with CH (OR, 3.4; 95% CI, 1.03-11.18). The adjusted mean charges rose from $7,733 in 2000 to $11,335 in 2003 and to $14,572 in 2006 (P < .01).
Conclusion:
CH had the shortest LOS and lowest complication rates. Despite a higher complication rate and longer LOS, GH had the lowest charges. There is an opportunity to identify best practices, to improve quality, and to lower costs for pyloromyotomy in the United States, regardless of hospital type.
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