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Published on: May 26, 2023
Hospital variation in postoperative mortality among preterm infants
Steven C Mehl1, Jorge I Portuondo2, Yao Tian3
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, USA.
Background:
It is unknown if there is hospital variation in postoperative mortality among infants. The purpose of this study is to describe variation in hospital postoperative mortality among infants and the extent to which gestational age may be a contributing factor.
Methods:
The Pediatric Health Information System® database (2012-2020) was used to identify infants (<365 days old at the time of surgery) who underwent one of 38 operations associated with significant postoperative morbidity and mortality. Infants were stratified by gestational age (>36 weeks, 33-36 weeks, 29-32 weeks, 25-28 weeks, <25 weeks). Hospitals were stratified into tertiles of risk and reliability-adjusted postoperative mortality (below average mortality [tertile 1-T1]; above average mortality [tertile 3-T3]). Nonparametric test of trend was used to compare mortality rates across hospital tertiles stratified by gestational age. Multivariable hierarchical regression was used to evaluate the association between mortality, hospital mortality tertile, and gestational age.
Results:
Overall, 69,963 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 3.4 % [2.5-4.3] to 8.8 % [7.7-10.0]. Relative to infants treated at T1 mortality hospitals, the odds of mortality increased by 75% at T3 mortality hospitals (odds ratio [OR] 1.75 [1.57-1.94]). This relationship was consistent across all gestational ages and demonstrated a dose-dependent association with decreasing gestational age for preterm infants (33-36 weeks, OR 1.52 [1.09-2.13]; 29-32 weeks, OR 1.59 [1.18-2.15]; 25-28 weeks, OR 1.77 [1.37-2.27]; <25 weeks, OR 2.06 [1.39-3.05]).
Conclusions:
There is over 2-fold variation in infant postoperative mortality with variation more pronounced among infants with extreme prematurity (≤28 weeks). These findings suggest future work is needed to understand the care processes at high performing centers associated with better surgical outcomes.
Level Of Evidence:
Level II, Retrospective cohort study.
