Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis

Area of Science:

• Pediatric Surgery
• Health Services Research
• Surgical Outcomes

Background:

• Limited evidence exists on the association between hospital volume and pediatric surgery outcomes.
• Understanding this relationship is crucial for optimizing care and resource allocation in pediatric surgery.

Purpose of the Study:

• To investigate the association between hospital surgical volume and postoperative outcomes in pediatric major surgery.
• To analyze the impact of hospital volume on mortality and major complications within 30 and 90 days post-surgery.

Main Methods:

• Utilized a nationwide database of pediatric patients undergoing major elective inpatient surgery.
• Analyzed 30-day and 90-day postoperative outcomes, including mortality and major complications, stratified by hospital volume (low, middle, high).

Main Results:

• No significant difference in 30-day postoperative mortality across hospital volume groups.
• Middle- and high-volume hospitals showed significantly lower rates of 30-day major complications, especially deep wound infections.
• High-volume hospitals demonstrated significantly lower 90-day mortality and major complication rates (deep wound infection, pneumonia, septicemia).

Conclusions:

• Pediatric patients undergoing major surgery in middle- and high-volume hospitals experience better outcomes regarding major complications.
• High hospital volume is associated with reduced risk of mortality and major complications, emphasizing the importance of specialized pediatric surgical centers.
• Findings support the development of guidelines for hospital selection to improve pediatric surgical outcomes and inform health policy.