Hospital variation in postoperative mortality among preterm infants.

Area of Science:

• Pediatric Surgery
• Healthcare Quality and Safety
• Neonatal Medicine

Background:

• Significant variation in postoperative mortality among infants across hospitals is not well-documented.
• Gestational age is a potential factor influencing infant postoperative mortality rates.

Purpose of the Study:

• To quantify hospital variation in postoperative mortality for infants undergoing major surgery.
• To investigate the role of gestational age as a contributing factor to this observed variation.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System® database (2012-2020).
• Identified infants (<365 days) undergoing 38 high-risk operations, stratified by gestational age.
• Hospitals categorized into tertiles based on risk- and reliability-adjusted postoperative mortality.

Main Results:

• Analysis included 69,963 infants across 48 pediatric hospitals; adjusted mortality rates varied significantly between hospitals.
• Infants at high-mortality hospitals (T3) had a 75% increased odds of mortality compared to low-mortality hospitals (T1).
• This association persisted across all gestational ages, with a dose-dependent increase in mortality odds for preterm infants as gestational age decreased.

Conclusions:

• Substantial variation exists in infant postoperative mortality, with greater disparities observed in extremely premature infants (<28 weeks).
• Findings underscore the need to identify and understand care processes at high-performing centers to improve surgical outcomes for vulnerable infants.