A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes.
OBJECTIVE
The availability of large clinical databases allows for careful evaluation of surgical practices, indicators of quality improvement, and cost. We used a large clinical database to compare the effect of surgeon and hospital volume for the care of children with hypertrophic pyloric stenosis (HPS).


METHODS
Patients with International Classification of Diseases-9 codes for HPS and pyloromyotomy were selected from the 1994 to 2000 National Inpatient Samples database. Multiple and logistic regression models were used to evaluate the risk-adjusted association between provider volume and outcomes.


RESULTS
Postoperative complications occurred in 2.71% of patients. Patients operated on by low- and intermediate-volume surgeons were more likely to have complications compared with those operated on by high-volume surgeons (95% confidence interval [CI], 1.25-3.78 and 95% CI, 1.25-2.69, respectively). Patients operated at low-volume hospitals were 1.6 times more likely to have complications compared with those operated at intermediate- or high-volume hospitals (95% CI, 1.19-2.20). Procedures performed at high-volume hospitals were less expensive than those at intermediate-volume hospitals by a margin of 910 dollars (95% CI, 443-1377 dollars).


CONCLUSIONS
These data represent the largest study to date on the epidemiology, complication rate, and cost for care for HPS. Patients treated by both high-volume surgeons and at high-volume hospitals have improved outcomes at less cost.
Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Box 31291, Durham, NC 27710, USA. saffo001@mc.duke.edu
Shawn D
SD
Safford
Ricardo
R
Pietrobon
Kristine M
KM
Safford
Henrique
H
Martins
Michael A
MA
Skinner
Henry E
HE
Rice
D002983:Clinical Competence / Q000191:economics / Q000706:statistics & numerical data*; D019992:Databases as Topic; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005753:Gastric Mucosa / Q000293:injuries; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000293:injuries; D007416:Intestinal Perforation / Q000453:epidemiology; D007431:Intraoperative Complications; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D046248:Pyloric Stenosis, Hypertrophic / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies