title: Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis.
abstract: BACKGROUND
  Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems.
  
  
  OBJECTIVE
  To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care.
  
  
  METHODS
  We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume.
  
  
  RESULTS
  We reviewed 257,541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two-thirds of all inpatient anesthetics; 385 non-CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low- and intermediate-volume centers (n = 297) and 100% of the high- and very high-volume centers (n = 41). Ninety percent (n = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low- and intermediate-volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower-volume hospitals to the nearest high- or very high-volume center was 12 miles. Up to 98% (n = 40,316) of inpatient anesthetics at low- or intermediate-volume centers could have been transferred to higher-volume centers within 25 miles of smaller centers.
  
  
  CONCLUSIONS
  Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low- and intermediate-volume hospitals in California.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; Anesthesia and Perioperative Medicine Service, VA Palo Alto HCS, Palo Alto, CA, USA.
authors.forename: Seshadri C
authors.initials: SC
authors.lastname: Mudumbai
authors.forename: Anita
authors.initials: A
authors.lastname: Honkanen
authors.forename: Jia
authors.initials: J
authors.lastname: Chan
authors.forename: Susan
authors.initials: S
authors.lastname: Schmitt
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.forename: Alvin
authors.initials: A
authors.lastname: Hackel
authors.forename: George
authors.initials: G
authors.lastname: Gregory
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000758:Anesthesia / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005006:Ethnicity; D005260:Female; D005843:Geography; D006761:Hospitals / Q000145:classification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D012040:Regional Health Planning; D012424:Rural Population; D012737:Sex Factors; D014505:Urban Population
keywords: delivery of health care; geographic variation; health policy; hospital; pediatric anesthesia; regionalization