Objective: To determine whether procedure specific provider volume is associated with outcomes for patients undergoing repair of pectus excavatum () at tertiary care children's hospitals.
Study design: We performed a cohort study of patients undergoing repair of PE between 01/01/2013 and 12/31/2019 at children's hospitals using the Pediatric Health Information System (PHIS) database. The main exposures were the PE repair volume quartile of the patient's hospital and the PE repair volume category of their surgeon. Our primary outcome was surgical complication, identified using ICD-9-CM and ICD-10-CM codes from PHIS. Secondary outcomes included high cost admission and extended length of stay.
Results: 7183 patients with average age 15.2 years (SD:2.0), 83% male, 74% non-Hispanic whites, 68% no comorbidities, 72% private insurance and 82% from metro areas were analyzed. Compared with the lowest volume (≤10 cases/year) quartile of hospitals, patients undergoing repair of PE at hospitals in the 2nd (>10-18 cases/year), 3rd (>18-26 cases/year) and 4th (>26 cases/year) volume quartiles had decreased odds of complication of (OR) 0.52 (CI: 0.34-0.82), 0.51(CI: 0.33-0.78) and 0.41 (CI: 0.27-0.62) respectively. PE patients undergoing repair by surgeons in the 2nd (>1-5 cases/year), 3rd (>5-10 cases/year) and 4th (>10 cases/year) volume categories had decreased odds of complication of (OR=0.91; [CI: 0.68-1.20]), (OR=0.73; [CI: 0.51-1.04]) and (OR=0.55; [0.39-0.76]) respectively, compared with the lowest volume (≤1case/year) category of surgeons.
Conclusion: Procedure specific case volume is an important factor when considering providers for elective surgery, even among specialized centers providing comprehensive patient care.
DOI: 10.1016/j.jpeds.2021.12.053
