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Hospital Variation in Mortality After Inpatient Pediatric Surgery.

Steven C Mehl1,2, Jorge I Portuondo1, Yao Tian3,4

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This summary is machine-generated.

Failure to rescue (FTR) rates, not complications, significantly increased in higher-mortality pediatric surgery hospitals. This suggests improved recognition and management of complications could reduce pediatric surgical mortality.

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Area of Science:

  • Pediatric surgery
  • Healthcare quality improvement
  • Patient safety

Background:

  • Hospital variation in perioperative mortality is partly explained by failure to rescue (FTR) in adults.
  • The role of FTR in pediatric surgical mortality variation is not well understood.

Purpose of the Study:

  • To determine the association between risk-adjusted hospital mortality rates, postoperative complications, and FTR in pediatric surgery.
  • To investigate if FTR explains variations in mortality across pediatric hospitals.

Main Methods:

  • Analysis of the Pediatric Health Information System database (2012-2020) for 203,242 high-risk pediatric surgeries.
  • Stratification of 48 academic pediatric hospitals into quintiles based on risk-adjusted mortality.
  • Use of multivariable hierarchical regression to assess the relationship between mortality, complications, and FTR.

Main Results:

  • Inpatient mortality, complication, and FTR rates were 2.3%, 8.8%, and 8.8%, respectively.
  • A minority of deaths (34.1%) were preceded by a complication.
  • Higher mortality hospitals showed significantly increased FTR rates (OR: 1.60) but not complication rates (OR: 1.02).

Conclusions:

  • While most pediatric surgical deaths are not preceded by complications, variations in mortality may stem from differences in complication recognition and management.
  • Further research is needed to identify pediatric patients most at risk for death due to perioperative complications versus pre-existing conditions.