Location of Treatment Among Infants Requiring Complex Surgical Care

Area of Science:

• Pediatric Surgery
• Healthcare Access
• Rural Health Disparities

Background:

• Rural children face worse health outcomes than urban counterparts, potentially due to reduced access to specialized pediatric care.
• Children's hospitals are key centers for advanced pediatric medical services.

Purpose of the Study:

• To investigate the types of hospitals providing complex surgical care to infants nationwide.
• To analyze the association between patient residence (rural vs. urban) and the location of specialized surgical care.

Main Methods:

• Analysis of infants (<1 year old) undergoing surgery for specific congenital conditions using the Kids' Inpatient Database (2009-2019).
• Comparison of care location (children's hospital vs. other) based on patient residence using multivariable logistic regression.
• Inclusion of conditions: esophageal atresia, gastroschisis, omphalocele, Hirschsprung disease, anorectal malformation, pyloric stenosis, small bowel atresia, congenital diaphragmatic hernia, and necrotizing enterocolitis.

Main Results:

• Among 29,185 infants, 16.0% resided in rural areas; these infants were more likely to be White, from lower income quartiles, and from the South/Midwest.
• Complex infant surgeries predominantly occurred in urban teaching hospitals (94.1%), not exclusively children's hospitals.
• Rural infants were significantly less likely to receive care at a children's hospital (aOR 0.66 in 2009, aOR 0.78 in 2012-2019) after adjusting for covariates.

Conclusions:

• A significant proportion of complex infant surgical care occurs outside children's hospitals, particularly for rural populations.
• Disparities in access to specialized pediatric surgical care exist for rural infants.
• Further research and interventions are needed to improve access to children's hospitals for rural children requiring complex surgical interventions.