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Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis
Seshadri C Mudumbai1, Anita Honkanen, Jia Chan
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesia and Perioperative Medicine Service, VA Palo Alto HCS, Palo Alto, CA, USA.
Insights
Many California hospitals perform few pediatric anesthetics annually, even for complex surgeries. Regionalizing care could improve outcomes for children needing surgery, as many low-volume centers are near high-volume facilities.
Area of Science:
- Pediatric Anesthesiology
- Healthcare Systems Analysis
- Surgical Outcomes Research
Background:
- Regional referral systems are vital for pediatric surgical patients.
- Existing systems for pediatric surgical care lack comprehensive data.
- Understanding current anesthetic caseloads is crucial for system improvement.
Purpose of the Study:
- To analyze geographic variations in pediatric anesthetic caseloads in California.
- To assess the feasibility of regionalizing anesthetic care for pediatric surgical patients.
- To identify patterns in hospital volume and procedure complexity.
Main Methods:
- Retrospective review of California patient discharge data (2000-2009).
- Analysis of inpatient anesthetic caseloads for surgical patients aged ≤6 years.
- Hospital classification by urban/rural status and volume (low to very high).
Main Results:
- 402 hospitals and 257,541 anesthetic cases were reviewed.
- Seventeen California Children's Services (CCS) hospitals handled two-thirds of anesthetics.
- 90% of hospitals performed fewer than 100 cases annually, with urban centers often having low volumes despite complex procedures.
Conclusions:
- Many urban California hospitals have low annual pediatric anesthetic caseloads.
- These low-volume centers perform a range of procedures, including complex ones.
- Further research is needed to define the scope of pediatric anesthetic care at these facilities and inform regionalization efforts.
Background:
Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems.
Objectives:
To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care.
Methods:
We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume.
Results:
We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers.
Conclusions:
Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.
