title: Factors affecting innovation in pediatric surgery: hospital type and appendectomies.
abstract: BACKGROUND
  There are little data on whether patient or hospital characteristics affect utilization of innovative surgical techniques in children, especially with respect to laparoscopic appendectomy (LA), whose benefit over existing treatment remains unproven. This study examines the patterns of LA using a national database, focusing on variations in care between children's and general hospitals.
  
  
  METHODS
  Using data from the 2000 Healthcare Costs and Utilization Project Kid's Inpatient Database for patients aged 5 to 20 years with a discharge diagnosis of appendectomy, we analyzed the relationship between LA and patient demographic and hospital characteristic variables.
  
  
  RESULTS
  The Healthcare Costs and Utilization Project Kid's Inpatient Database included 50,825 pediatric appendectomies (26% LA) representing 97,205 cases in the nation. Children's hospitals and children's units were significantly more likely to provide LA (36% and 28%, respectively) than general hospitals (25%). Higher LA rates were also associated with greater patient age, female sex, nonperforated appendicitis, private insurance, and white patient race. The children's hospital effect compared to general hospitals (adjusted odds ratio, 2.11; 95% confidence interval, 1.88-2.38) and all other relationships remained significant in the multivariate model.
  
  
  CONCLUSIONS
  Utilization of LA is significantly higher in children's hospitals. Children's hospitals appear more likely to adopt innovative surgical procedures, such as LA, even when clear benefit over standard treatment has not yet emerged.
authors.affiliation: Department of Pediatrics, The Ohio State University, College of Medicine and Columbus Children's Research Institute, Columbus, OH 43205, USA. chisolmd@ccri.net <chisolmd@ccri.net>
authors.forename: Deena J
authors.initials: DJ
authors.lastname: Chisolm
authors.forename: Cedric V
authors.initials: CV
authors.lastname: Pritchett
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D019992:Databases as Topic; D003710:Demography; D004059:Diffusion of Innovation; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D035703:Therapies, Investigational / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review