title: In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care.
abstract: OBJECTIVE
  Death after ventriculoperitoneal (VP) shunt surgery is uncommon, and therefore it has been difficult to study. The authors used a population-based national hospital discharge database to examine the relationship between annual hospital and surgeon volume of VP shunt surgery in pediatric patients and in-hospital mortality rates.
  
  
  METHODS
  All children in the Nationwide Inpatient Sample (1998-2000, age 90 days-18 years) who underwent VP shunt placement or shunt revision as the principal procedure were included. Main outcome measures were in-hospital mortality rates, length of stay (LOS), and total hospital charges. Overall, 5955 admissions were analyzed (253 hospitals, 411 surgeons). Mortality rates were lower at high-volume centers and for high-volume surgeons. In terms of hospital volume, the mortality rate was 0.8% at lowest-quartile-volume centers (< 28 admissions/year) and 0.3% at highest-quartile-volume centers (> 121 admissions/year). In terms of surgeon volume, the mortality rate was 0.8% for lowest-quartile-volume providers (< nine admissions/year) and 0.1% for highest-quartile-volume providers (> 65 admissions/year). After multivariate adjustment for demographic variables, emergency admission and presence of infection, hospital volume of care remained a significant predictor of death (odds ratio [OR] for a 10-fold increase in caseload 0.38; 95% confidence interval [CI] 0.18-0.81). Surgeon volume of care was statistically significant in a similar multivariate model (OR for a 10-fold increase in caseload 0.3; 95% CI 0.13-0.69). Length of stay was slightly shorter and total hospital charges were slightly higher at higher-volume centers, but the differences were not statistically significant.
  
  
  CONCLUSIONS
  Pediatric shunt procedures performed at high-volume hospitals or by high-volume surgeons were associated with lower in-hospital mortality rates, with no significant difference in LOS or hospital charges.
authors.affiliation: Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.forename: William E
authors.initials: WE
authors.lastname: Butler
authors.forename: Fred G
authors.initials: FG
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006753:Hospital Records; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015233:Models, Statistical; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt / Q000401:mortality*