Variation in Outcomes for Congenital Anomaly Patients Across Texas Health Service Regions

Congenital anomalies (CAs) are a leading cause of neonatal morbidity and often require early surgical intervention. Access to timely, specialized care remains a geographic challenge. The American College of Surgeons' Children's Surgery Verification (CSV) Program aims to improve outcomes through standardized, high-resource centers. However, the impact of CSV programs on regional access and disparities remains understudied. This study evaluates regional variation in infant CA admissions across eight Texas Health Service Regions (HSRs), focusing on the role of CSV level I centers in mitigating disparities.

We performed a retrospective cohort study using the Texas Inpatient Public Use Data to query infants (<365 d) statewide (2018-2024) for admissions with CA by International Classification of Diseases, 10th Revision codes. Admissions were stratified by HSR, three of these regions contain CSV level I centers (HSR 2/3, 5S/6, and 7). In order to avoid systematic double counting, transfer to outside hospitals were excluded. Descriptive statistics were performed.

We identified 339,391 CA infant admissions. HSRs 2/3 and 5S/6 represent the highest volume of admissions, while HSR 1, 4/5N, and 9/10 had significantly fewer. Overall median length of stay, rate of operative admissions, and charges were similar across regions. Across the state, operative admissions had longer length of stay, higher inpatient charges, and increased mortality across the cohort compared with nonoperativ admissions. This discrepancy was most pronounced in 'specialized pediatric care deserts' (HSRs 9/10 and 11), where mortality rates were highest. Among the most critically ill (Illness Severity Score 4) admissions, mortality was lower at CSV facilities (8.8%) than non-CSV (11.8%) with CSV facilities treating a much higher proportion of Illness Severity Score 4 admissions (42.6% versus 8.6%), urgent/emergent admissions (CSV: 53.9% versus non-CSV: 9.1%), and accepting interfacility transfers (CSV: 31.9% versus non-CSV: 4.8%). A notable proportion of patients from HSRs without a CSV facility still received care at CSV centers, indicating regionalized referral patterns.

Significant regional variation exists in infant surgical care across Texas. While CSV level I facilities may improve mortality despite higher acuity, these benefits are attenuated for infant admissions from remote regions. These findings highlight the need for regionalized surgical systems and suggest that improving timely access to CSV level I care in underserved regions may reduce mortality disparities.