Hospital Variation in Mortality and Failure to Rescue after Surgery for High-Risk Neonatal Diagnoses.

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Healthcare Quality Improvement

Background:

• Postoperative mortality disproportionately affects neonates with specific high-risk diagnoses.
• Understanding hospital-level variation in mortality and its drivers is crucial for improving outcomes.

Purpose of the Study:

• To investigate hospital-level mortality variation for neonates undergoing surgery for high-risk diagnoses.
• To determine if this variation is associated with differences in failure to rescue (FTR).

Main Methods:

• Analysis of the Pediatric Health Information System® database (2012-2020).
• Inclusion of 20,838 infants across 48 academic pediatric hospitals undergoing surgery for eight high-risk neonatal diagnoses.
• Stratification of hospitals by reliability-adjusted inpatient mortality rates and use of multivariable hierarchical regression to assess the association between mortality and FTR.

Main Results:

• Significant variation in adjusted hospital mortality rates (4.0% to 16.3%) was observed.
• Hospitals with the highest mortality rates showed significantly higher odds of failure to rescue (OR 1.97) compared to those with the lowest mortality.
• Hospital structural characteristics like case volume and NICU beds did not differ significantly across mortality groups.

Conclusions:

• Hospital-level mortality variation in high-risk neonatal surgery is not explained by structural factors.
• Differences in failure to rescue suggest that quality improvement initiatives focused on early recognition and management of postoperative complications are essential.
• Targeted interventions can enhance surgical quality and safety for critically ill neonates.