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Understanding the relationship between hospital volume and patient outcomes for infants with gastroschisis
Genia Dubrovsky1, Greg D Sacks1, Scott Friedlander2
1Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Insights
High-volume hospitals did not improve outcomes for infants with gastroschisis (a congenital abdominal wall defect). This study suggests the benefits of high-volume centers may not apply to this specific pediatric surgery.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Neonatal Care
Background:
- A strong link exists between surgical volume and patient outcomes in many procedures.
- The relationship between hospital volume and outcomes for gastroschisis repair in infants is not well-established.
Purpose of the Study:
- To investigate the association between hospital surgical volume and outcomes for infants undergoing gastroschisis repair.
- To determine if high-volume hospitals offer better results for gastroschisis treatment.
Main Methods:
- Retrospective analysis of the Kids' Inpatient Database (2003-2012).
- Identified infants undergoing gastroschisis repair, comparing outcomes across hospital volume quartiles.
- Controlled for patient demographics and disease complexity (e.g., necrotizing enterocolitis, respiratory distress syndrome).
Main Results:
- Analyzed 7,769 infants from 743 hospitals; most were low-volume.
- High-volume hospitals showed similar mortality and TPN cholestasis rates compared to low-volume hospitals.
- Infants at high-volume hospitals experienced a longer length of stay.
Conclusions:
- Gastroschisis repair outcomes were not improved at high-volume hospitals.
- The volume-outcome relationship seen in other complex pediatric surgeries may not extend to gastroschisis.
- Hospital volume is not a significant predictor of improved outcomes for gastroschisis.
Background:
For many surgical operations, there is a well-established relationship between surgical volume and outcome. We investigated whether this relationship exists for infants with gastroschisis.
Methods:
Using the Kids' Inpatient Database for years 2003, 2006, 2009, and 2012, we identified all patients undergoing gastroschisis repair. Controlling for patient characteristics and complexity of disease (comorbid intestinal atresia/perforation, necrotizing enterocolitis, and respiratory distress syndrome), we compared surgical outcomes (mortality, length of stay, and incidence of TPN cholestasis) by hospital volume based on quartile for gastroschisis cases treated per year.
Results:
We identified 7769 patients treated at 743 hospitals. The majority of hospitals were low-volume (n=445), while only 49 were high-volume. The overall mortality rate was 4.3%, and the median length of stay was 34days. Adjusting for clinical and demographic characteristics, patients treated at high-volume hospitals had similar rates of TPN cholestasis and similar mortality rates, but a higher chance for a prolonged length of stay compared to those treated at low-volume hospitals.
Conclusions:
Using national data, we found that gastroschisis patients treated at high-volume hospitals did not have improved outcomes. The benefits of high-volume hospitals, which seem to be important for complex pediatric surgery, may not apply to treatment of gastroschisis.
Level Of Evidence:
Level III Retrospective Study.
