Population-based cohort study of the correlation between provision of care and the risk for complications after appendectomy in children
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Read the article on jpedsurg.org ↗Article · Apr 2019 · 1 min read
In brief
In brief
This Swedish population-based study of 55,591 children demonstrates that specialized pediatric surgical centers and high-caseload hospitals have significantly lower postoperative complication rates after appendectomy. The findings suggest that improved outcomes can be achieved either through centralization to pediatric centers or by increasing surgical volume at non-specialized units.
Written by the GCMD Library team from the article.
Purpose
To investigate the impact of hospital administrative level and caseload of pediatric appendectomies on the morbidity and mortality after appendectomy in a population-based cohort of Swedish children.
Methods
Population-based cohort study including all Swedish children less than 15 years of age that underwent appendectomy for suspected appendicitis, 1987–2009. Patient characteristics and data on postoperative morbidity and mortality were collected from the Swedish National Patient Register and the Swedish Death Register. Primary endpoints were postoperative morbidity and mortality. Two explanatory variables were investigated: hospital administrative level and hospital annual caseload of pediatric appendectomies. Data were analyzed in regression models adjusting for available confounders.
Results
The cohort comprised 55,591 children. The risk for postoperative complications was reduced in specialized pediatric surgical centers and in high caseload centers, compared to other hospitals. There were only seven postoperative deaths within 90 days of appendectomy.
Conclusions
We found clinically relevant risk reductions for reoperation and for readmission after appendectomy in specialized pediatric surgical centers. Importantly, the risk for postoperative complications was also reduced with increased hospital caseload, indicating that the merit from centralizing the management of pediatric appendectomies to specialized pediatric surgical centers may also be achieved by increasing hospital caseload of pediatric appendectomies in non-pediatric surgical units.
Type of study
Treatment study.
Level of evidence
Level II.