title: Outcomes in pediatric surgery by hospital volume: a population-based comparison.
abstract: OBJECTIVE
  The volume-outcome relationship has not been well-defined in pediatric surgery. Our aim was to determine the association between hospital-volume and outcomes for common procedures in children.
  
  
  METHODS
  Retrospective population-based cohort study of patients <18 years of age hospitalized between 1989 and 2009 for common surgical procedures in Washington State. The association between annual hospital case volume and post-operative outcomes (readmission and reoperation within 30-days, post-operative complications) was assessed using multivariate logistic regression.
  
  
  RESULTS
  The three most common procedures over the study period were appendectomy (n = 36,525), skin and soft tissue debridement (n = 9,813), and pyloromyotomy (n = 3,323). A greater proportion of patients with comorbidities were treated at higher-volume hospitals. After adjustment, outcomes did not differ significantly across hospital-volume quartiles except that debridement patients had lower odds of readmission (OR = 0.63, 95 % CI 0.46-0.88) and re-operation (OR = 0.53, 95 % CI 0.35-0.81) at medium-high-volume compared with high-volume centers.
  
  
  CONCLUSIONS
  This work suggests that risks of readmission and post-operative complications for common procedures may be similar across hospital-volume categories, but appropriate risk-stratification is essential. In order to optimize safety, we must identify the resources required for low-, medium-, and high-risk surgical patients, and implement these standards into practice.
authors.affiliation: Department of Surgery, Louisiana State University, New Orleans, LA 70112, USA.
authors.forename: Cabrini A
authors.initials: CA
authors.lastname: LaRiviere
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Huaco
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Garrison
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Avansino
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Keith T
authors.initials: KT
authors.lastname: Oldham
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology