title: Patterns of surgical practice in very low birth weight neonates born in the United States: a Vermont Oxford Network analysis.
abstract: OBJECTIVE
  The distribution of surgical care of very low birth weight (VLBW) neonates among centers with varying specialized care remains unknown. This study quantifies operations performed on VLBW neonates nationally with respect to center type.
  
  
  METHODS
  VLBW neonates born 2009-2012 were assessed using a prospectively collected multi-center database encompassing 80% of all VLBW neonates in the United States. Surgical centers were categorized based on availability of pediatric surgery (PS) and anesthesia (PA).
  
  
  RESULTS
  48,711 major procedures (29,512 abdominal operations) were performed on 24,318 neonates. Of all patients, 20,892 (85.9%) underwent surgery at centers with PS and PA available on site. 1663 (6.8%) patients were treated at centers with neither specialty on site. Neonates requiring complex operations were more likely to receive surgery at centers with both PS and PA on staff than those requiring non-complex operations (95.6% vs 93.6%).
  
  
  CONCLUSIONS
  This study confirms that most operations on VLBW neonates in the U.S. are performed at centers with pediatric surgeons and anesthesiologists on staff. Further research is necessary, however, to elucidate why a significant minority of this challenging population continues to be managed at centers without pediatric specialists.
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Gutierrez
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Kuang Horng
authors.initials: KH
authors.lastname: Kang
authors.affiliation: Vermont Oxford Network, Burlington, VT.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Morrow
authors.affiliation: Vermont Oxford Network, Burlington, VT.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.affiliation: Vermont Oxford Network, Burlington, VT.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.affiliation: Vermont Oxford Network, Burlington, VT.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: biren.modi@childrens.harvard.edu.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D008297:Male; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000592:standards*; D014707:Vermont / Q000453:epidemiology
keywords: Children's surgery; Infant; Optimal resources; Outcomes; Quality; Very low birth weight