Hospital volumes for common pediatric specialty operations.
OBJECTIVE
To describe hospital volumes for common pediatric specialty operations, to evaluate hospital and patient characteristics associated with operations performed at a low-volume hospital, and to evaluate outcomes with hospital volume.


METHODS
Retrospective cohort using the Kids' Inpatient Database 2003.


METHODS
Discharges from 3438 hospitals in 36 states from 2003.


METHODS
Children aged 0 to 18 years undergoing ventriculoseptal defect surgery (n = 2301), tracheotomy (n = 2674), ventriculoperitoneal shunt placement (n = 3378), and posterior spinal fusion (n = 4002).


METHODS
Hospital volume.


METHODS
In-hospital mortality and postoperative complications.


RESULTS
For tracheotomy and posterior spinal fusion, at least one fourth of the hospitals performed only 1 operation for children aged 0 to 18 years in 2003. For these same operations, at least half of hospitals treated 4 or fewer cases per year. For all operations, discharges from low-volume hospitals were less likely to be from children's or teaching hospitals compared with discharges from higher-volume hospitals. For tracheotomy, children were less likely to experience postoperative complications in high-volume hospitals compared with low-volume hospitals (odds ratio, 0.48; 95% confidence interval, 0.21-1.09).


CONCLUSIONS
Many children undergoing common pediatric specialty operations had these procedures performed in low-volume hospitals. Low-volume hospitals were less likely to be children's or teaching hospitals. Children undergoing tracheotomy experienced higher rates of complications in low-volume hospitals. Further research is needed to identify the reasons why so many children have these operations performed in low-volume hospitals.
Berry
Jay G
JG
Harvard Pediatric Health Services Research Fellowship Program, Division of Infectious Diseases, Children's Hospital Boston, 1 Autumn Street, AU-522, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
Lieu
Tracy A
TA
Forbes
Peter W
PW
Goldmann
Don A
DA
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D014140:Tracheotomy / Q000706:statistics & numerical data*; D014481:United States; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*