Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases
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Read the article on jpedsurg.org ↗Article · Mar 2020 · 1 min read
In brief
In brief
Multi-center study of 2,270 neonatal cases examines whether concentrating complex procedures (CDH repair, EA/TEF repair, Hirschsprung pull-through) among fewer surgeons improves outcomes. While mortality and reoperation rates showed no difference, highly concentrated centers demonstrated reduced unplanned readmissions for Hirschsprung and CDH patients.
Written by the GCMD Library team from the article.
Background
The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. We elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.
Methods
We used data from 49 US children's hospitals between 2007 and 2017 for the following procedures: congenital diaphragmatic hernia repair (CDH), esophageal atresia and tracheoesophageal fistula repair (EA/TEF), and pull-through for Hirschsprung disease (HD). Mixed effects logistic regression modeling was used to adjust for salient patient characteristics to determine the effect of HHI on in-hospital mortality, condition-specific one-year re-operation, and one-year unplanned readmissions.
Results
A total of 2270 infants were identified who underwent surgery for the three conditions of interest. On multivariable analysis, increasing HHI was not associated with differences in mortality or condition-specific re-operation within the first year. A decrease in the number of unplanned readmissions at highly concentrated centers was seen for HD (RR 0.8 CI (0.69–0.97), p = 0.02) and CDH (RR 0.4 CI (0.28–0.71), p