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Population-based cohort study of the correlation between provision of care and the risk for complications after
Markus Almström1, Jan F Svensson1, Anna Svenningsson1
1Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Departments of Women's and Children's Health, Stockholm, Sweden.
Insights
Pediatric appendectomy outcomes improve in specialized centers and high-volume hospitals. Centralizing care or increasing caseload in existing units can reduce complications and reoperations for children undergoing appendectomy.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Epidemiology
Background:
- Appendectomy is a common pediatric surgical procedure.
- Variations in hospital care may impact patient outcomes.
- Understanding factors influencing pediatric appendectomy success is crucial.
Purpose of the Study:
- To examine how hospital administrative level and pediatric appendectomy caseload affect morbidity and mortality in children.
- To identify optimal hospital settings for pediatric appendectomy.
Main Methods:
- Population-based cohort study of 55,591 children (<15 years) undergoing appendectomy (1987-2009).
- Data sourced from Swedish National Patient Register and Swedish Death Register.
- Analysis of postoperative morbidity and mortality in relation to hospital administrative level and annual caseload.
Main Results:
- Reduced risk of postoperative complications in specialized pediatric surgical centers and high-caseload hospitals.
- Low overall postoperative mortality (7 deaths within 90 days).
- Increased hospital caseload correlated with reduced complication risk.
Conclusions:
- Specialized pediatric surgical centers demonstrate clinically relevant reductions in reoperation and readmission rates.
- Increased hospital caseload for pediatric appendectomies, even in non-specialized units, is associated with improved outcomes.
- Centralization of pediatric appendectomy care can yield benefits through increased caseload.
Purpose:
To investigate the impact of hospital administrative level and caseload of pediatric appendectomies on the morbidity and mortality after appendectomy in a population-based cohort of Swedish children.
Methods:
Population-based cohort study including all Swedish children less than 15 years of age that underwent appendectomy for suspected appendicitis, 1987-2009. Patient characteristics and data on postoperative morbidity and mortality were collected from the Swedish National Patient Register and the Swedish Death Register. Primary endpoints were postoperative morbidity and mortality. Two explanatory variables were investigated: hospital administrative level and hospital annual caseload of pediatric appendectomies. Data were analyzed in regression models adjusting for available confounders.
Results:
The cohort comprised 55,591 children. The risk for postoperative complications was reduced in specialized pediatric surgical centers and in high caseload centers, compared to other hospitals. There were only seven postoperative deaths within 90 days of appendectomy.
Conclusions:
We found clinically relevant risk reductions for reoperation and for readmission after appendectomy in specialized pediatric surgical centers. Importantly, the risk for postoperative complications was also reduced with increased hospital caseload, indicating that the merit from centralizing the management of pediatric appendectomies to specialized pediatric surgical centers may also be achieved by increasing hospital caseload of pediatric appendectomies in non-pediatric surgical units.
Type Of Study:
Treatment study.
Level Of Evidence:
Level II.
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