title: Volume-outcome effects for children undergoing resection of renal malignancies.
abstract: BACKGROUND
  Adults undergoing oncologic resections at low-volume centers experience increased perioperative morbidity and mortality. The volume-outcome effect has not been extensively studied in pediatric oncologic resections.
  
  
  METHODS
  To clarify volume-outcome effects in pediatric oncologic resections, we analyzed resection of renal malignancies in children less than 15 y of age. We conducted a cross-sectional analysis of hospital discharges included in the health care utilization project kids' inpatient database from 1997 to 2009, examining in-hospital operative complications, length of stay (LOS), and inflation-adjusted hospital charges. Hospital volume was expressed as low (n = 1-2), medium (n = 3-4), and high (n > 4) annual volume of resections.
  
  
  RESULTS
  One thousand five hundred thirty-eight patients underwent renal malignancy resection. Of these, 527 patients had resection in low-, 422 in medium-, and 589 in high-volume hospitals. Relative to low-volume hospitals, those resected in medium-volume hospitals had an odds ratio of 0.62 (95% confidence interval 0.39-0.99, P = 0.046) for operative complication and those in high-volume hospitals had an odds ratio of 1.02 (95% confidence interval 0.63-1.65, P = 0.95). There was no detectable association with LOS (P = 0.113) or inflation-adjusted charges (P = 0.331).
  
  
  CONCLUSIONS
  The number of complications, total charges, and LOS attributable to resection of a childhood renal malignancy did not differ among high-, medium-, or low-operative volume hospitals, although oncologic outcomes could not be determined because of the limited nature of this administrative database.
authors.affiliation: Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9780, USA. jason.axt@vanderbilt.edu
authors.forename: Jason R
authors.initials: JR
authors.lastname: Axt
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Murphy
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016522:Oncology Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*