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Published on: October 20, 2017
Scope of practice and outcomes of cerebrovascular procedures in children
Kimon Bekelis1, Symeon Missios2, Shannon Coy3
1Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03755, USA. kbekelis@gmail.com.
Insights
This study found no significant difference in outcomes for pediatric cerebrovascular procedures performed by adult versus pediatric-focused providers. Key outcomes like mortality and length of stay were similar across provider types.
Area of Science:
- Pediatric Neurology
- Vascular Surgery
- Health Services Research
Background:
- The scope of practice for providers performing pediatric cerebrovascular procedures is debated.
- Understanding the impact of provider specialization (adult vs. pediatric) on patient outcomes is crucial.
Purpose of the Study:
- To investigate the association between provider scope of practice and outcomes in pediatric cerebrovascular interventions.
- To determine if predominantly adult or pediatric practices influence patient outcomes.
Main Methods:
- A cohort study of pediatric patients (<18 years) undergoing cerebrovascular procedures from 2009-2013 using the SPARCS database.
- Propensity score conditioning and mixed effects analysis were used to control for confounding and hospital-level clustering.
Main Results:
- 1243 pediatric patients were included; 50.7% treated by predominantly adult providers, 49.3% by predominantly pediatric providers.
- No significant association was found between predominantly adult practice and inpatient mortality (OR, 1.20), discharge to a facility (OR, 1.50), or length of stay (LOS) (adjusted difference, 0.003).
- These findings remained consistent after propensity score adjustment.
Conclusions:
- No demonstrable difference in mortality, discharge disposition, or length of stay was observed between predominantly adult and predominantly pediatric providers for pediatric cerebrovascular procedures.
- Provider specialization does not appear to significantly impact key outcomes in this patient population.
Purpose:
The impact of scope of practice of providers (predominantly adult versus predominantly pediatric) on the outcomes of cerebrovascular procedures in children remains an issue of debate. We investigated the association of scope of practice with the outcomes of cerebrovascular interventions.
Methods:
We performed a cohort study of all pediatric patients (younger than 18 years old) who underwent cerebrovascular procedures from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning and mixed effects analysis to account for clustering at the hospital level.
Results:
During the study period, there were 1243 pediatric patients who underwent cerebrovascular procedures and met the inclusion criteria. Of these, 631 (50.7 %) underwent treatment by providers with predominantly adult practices and 612 (49.3 %) by physicians who operated predominantly on children. The mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.20; 95 % CI, 0.61-2.38), discharge to a facility (OR, 1.50; 95 % CI, 0.73-3.09), and length of stay (LOS) (adjusted difference, 0.003; 95 % CI, -0.09 to 0.10). These associations persisted in propensity-adjusted models.
Conclusions:
In a cohort of pediatric patients undergoing cerebrovascular procedures from a comprehensive all-payer database, we did not demonstrate a difference in mortality, discharge to a facility, and LOS between providers with predominantly adult and predominantly pediatric practices.
