title: Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States.
abstract: OBJECTIVE
  Hospital and provider surgical volume have been increasingly linked to surgical outcomes. However, this topic has rarely been addressed in children. We investigated whether hospital surgical volume impacts complication rates in pediatric urology.
  
  
  METHODS
  We retrospectively reviewed the Nationwide Inpatient Sample (1998 to 2011) for pediatric (18 years or younger) hospitalizations for urological procedures. We used ICD-9-CM codes to identify elective urological interventions and NSQIP® postoperative in hospital complications. Annual hospital surgical volume was calculated and dichotomized as high volume (90th percentile or above) or non-high volume (below 90th percentile).
  
  
  RESULTS
  We identified 158,805 urological admissions (114,634 high volume and 44,171 non-high volume hospitals). Of the hospitals 75% recorded fewer than 5 major pediatric urology cases performed yearly. High volume hospitals showed treatment of significantly younger patients (mean 5.4 vs 9.6 years, p < 0.001) and were more likely to be teaching hospitals (93% vs 71%, p < 0.001). The overall rate of NSQIP identified postoperative complications was higher at non-high volume vs high volume hospitals (11.6% vs 9.3%, p = 0.003). After adjusting for confounding effects patients treated at non-high volume hospitals remained more likely to suffer multiple NSQIP tracked postoperative complications, including acute renal failure (OR 1.4, p = 0.04), urinary tract infection (OR 1.3, p = 0.01), postoperative respiratory complications (OR 1.5, p = 0.01), systemic sepsis (OR 2.0, p ≤ 0.001), postoperative bleeding (OR 2.5, p < 0.001) and in hospital death (OR 2.2, p = 0.007).
  
  
  CONCLUSIONS
  Urological procedures performed in children at non-high volume hospitals were associated with an increased risk of in hospital, NSQIP identified postoperative complications, including a small but significant increase in postoperative mortality, mostly following nephrectomy and percutaneous nephrolithotomy.
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Hsin-Hsiao S
authors: HH
authors: Wang
authors: Duke University School of Medicine, Durham, North Carolina.
authors: Rohit
authors: R
authors: Tejwani
authors: Duke University School of Medicine, Durham, North Carolina.
authors: Haijing
authors: H
authors: Zhang
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: John S
authors: JS
authors: Wiener
authors: Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: jonathan.routh@duke.edu.
authors: Jonathan C
authors: JC
authors: Routh
mesh_terms: D002648:Child; D002675:Child, Preschool; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014570:Urologic Diseases / Q000401:mortality / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*
keywords: high-volume; hospitals; low-volume; pediatrics; postoperative complications; urologic surgical procedures
references: N Engl J Med. 2002 Apr 11;346(15):1128-37
references: 11948273
references: Ann Surg. 2015 Apr;261(4):632-6
references: 24743604
references: Ann Intern Med. 2002 Sep 17;137(6):511-20
references: 12230353
references: J Clin Oncol. 2003 Feb 1;21(3):401-5
references: 12560426
references: N Engl J Med. 2003 Nov 27;349(22):2117-27
references: 14645640
references: N Engl J Med. 1979 Dec 20;301(25):1364-9
references: 503167
references: Med Care. 1980 Sep;18(9):940-59
references: 7432019
references: Health Serv Res. 1987 Jun;22(2):157-82
references: 3112042
references: Med Care. 1998 Jan;36(1):8-27
references: 9431328
references: Ann Surg. 1998 Oct;228(4):491-507
references: 9790339
references: J Urol. 2004 Dec;172(6 Pt 1):2145-52
references: 15538220
references: J Pediatr Surg. 2005 Jan;40(1):75-80
references: 15868562
references: J Urol. 2005 Aug;174(2):432-8
references: 16006859
references: Surgery. 2009 Jan;145(1):76-85
references: 19081478
references: J Am Coll Surg. 2009 Apr;208(4):599-606
references: 19476796
references: Ann Surg. 2009 Dec;250(6):1029-34
references: 19953723
references: J Pediatr Surg. 2010 Jan;45(1):108-13
references: 20105589
references: Pediatrics. 2010 Dec;126(6):1182-90
references: 21041285
references: Pediatrics. 2012 Feb;129(2):e370-6
references: 22232310
references: Ann Thorac Surg. 2012 Jun;93(6):1992-7
references: 22516833
references: JAMA Pediatr. 2013 May;167(5):468-75
references: 23529612
references: Pediatr Cardiol. 2013 Jun;34(5):1226-36
references: 23377381
references: Eur Urol. 2013 Nov;64(5):786-98
references: 23664423
references: Med Care. 2013 Dec;51(12):1040-7
references: 24226304
references: Surgery. 2014 Aug;156(2):467-74
references: 24953271
references: Ann Surg. 2014 Aug;260(2):244-51
references: 24368634
references: Med Care. 2014 Dec;52(12):1023-9
references: 25226544