Neighborhood Opportunity, Hospital Volume, and Pediatric Postoperative Mortality

Area of Science:

• Pediatric Surgery
• Health Disparities
• Social Determinants of Health

Background:

• Sociodemographic factors influence pediatric perioperative care, often concentrating disadvantaged populations in lower-volume hospitals.
• Neighborhood conditions are critical for child health, but their impact on postoperative mortality alongside hospital volume is not well understood.

Purpose of the Study:

• To examine the association between neighborhood opportunity and pediatric postoperative mortality.
• To determine if hospital volume modifies the relationship between neighborhood opportunity and mortality.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System (PHIS) database (2012-2024).
• Included inpatient surgical encounters for children under 18.
• Neighborhood opportunity measured by the Child Opportunity Index 3.0; hospital volume categorized as high or low.

Main Results:

• Higher neighborhood opportunity was linked to lower in-hospital postoperative mortality risk.
• Children in very low opportunity neighborhoods had a 27% higher mortality risk compared to those in very high opportunity areas.
• Care at low-volume centers was associated with an 11% higher mortality risk, but hospital volume did not alter the neighborhood opportunity-mortality association.

Conclusions:

• Neighborhood opportunity is a significant factor in pediatric postoperative mortality.
• Disparities in surgical outcomes for children from disadvantaged neighborhoods persist, even in high-volume centers.
• Addressing area-level social determinants of health is essential for improving pediatric surgical care equity.