Parental preferences for pediatric surgical facility centralization: insights from a discrete choice experiment

This study aimed to quantify the trade-off between benefits of pediatric surgical facility centralization and reduced accessibility.

A discrete choice experiment was conducted among parents of neonatal patients at Takatsuki Hospital (January 2021 to March 2024). Hypothetical facilities with varying levels of seven attributes-surgeon numbers and emergency coverage (EC), annual surgical volume, travel time, availability of pediatric specialists, advanced surgical capability, postoperative complication rates, and primary physician system-were presented. Preferences for each attribute and marginal rates of substitution with respect to travel time were estimated.

We analyzed 317 sets from 646 responses. Preferences were significantly influenced by surgeon numbers and EC, annual surgical volume, and travel time. Compared to "one surgeon/no EC," "three surgeons/daytime EC" and "seven surgeons/24 h EC" were valued equivalent to 99 and 249 min travel time increases. "Medium (≥ 1, < 6 cases/year)" and "high (≥ 6 cases/year)" were preferred over "low (< 1 case/year)" surgical volumes, equivalent to 123 and 219 min increases. Availability of other specialists (64 min), advanced surgery (33 min), and lower complications (24 min) were also valued. Team-based care was less preferred (- 26 min).

Parents support centralization of pediatric surgical facilities, placing greater emphasis on structural improvements than direct clinical outcomes.