title: Frequency and variety of inpatient pediatric surgical procedures in the United States.
abstract: OBJECTIVE
  Pediatric surgical procedures are being performed in a variety of hospitals with large differences in surgical volume. We examined the frequency and variety of inpatient pediatric surgical procedures in the United States by hospital type and geographic region using a nationally representative sample.
  
  
  METHODS
  The 2009 Kids' Inpatient Database for patients <18 years old was used to calculate surgical frequencies by using International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) codes. We performed stratified analysis by hospital type (free-standing children's hospital, children's unit within an adult hospital, and general hospital) and geographic region (South, West, Midwest, Northeast) to compare frequencies of surgical procedures.
  
  
  RESULTS
  A total of 216 081 procedures were projected for 2009 with the top 20 procedures accounting for >90% of cases. As many as 40% of all pediatric inpatient surgical procedures are being performed in adult general hospitals. Infrequent complex low-volume neonatal surgical procedures (pullthrough for Hirschsprung disease, surgery for malrotation, esophageal atresia repair, and diaphragmatic hernia repair) were 6.8 to 16 times more likely to occur in a children's hospital. Significant regional variation in procedure frequency rates occurred for appendectomy and cholecystectomy.
  
  
  CONCLUSIONS
  This report is the first to characterize pediatric surgical inpatient volume in the United States. Such data may influence the distribution of pediatric surgeons, number of trainees, and training curricula for pediatric surgeons, pediatricians, general surgeons and other surgical specialists who might operate on children. In addition, it raises the question of whether complex pediatric surgical procedures should preferably be performed at dedicated high volume children's hospitals.
authors.affiliation: Children's Hospital Colorado, B323, 13123 E 16th Ave, Aurora, CO 80045. stig.somme@childrenscolorado.org.
authors.forename: Stig
authors.initials: S
authors.lastname: Sømme
authors.forename: Michael
authors.initials: M
authors.lastname: Bronsert
authors.forename: Elaine
authors.initials: E
authors.lastname: Morrato
authors.forename: Moritz
authors.initials: M
authors.lastname: Ziegler
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D013502:General Surgery / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000458:organization & administration / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000458:organization & administration / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States
keywords: demography; epidemiology; pediatric surgery; work force allocation