title: Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy.
abstract: BACKGROUND
  The effects of hospital location and designation on postoperative pediatric outcomes remain unclear. We hypothesized that urban hospital outcomes would be superior to rural hospitals, and that outcomes at urban centers would differ for children from rural versus urban counties.
  
  
  METHODS
  Retrospective cohort study of children undergoing appendectomy (n=129,507) and pyloromyotomy (n=13,452) using the 2006/2009 KID databases. Hospitals were characterized by specialty designation and classified as urban/rural. County of residence was classified as urban/rural. Outcomes included complications and length of stay. Multivariate regression models were used to adjust for confounding.
  
  
  RESULTS
  Among appendectomy patients, treatment at urban hospitals was associated with reduced odds of any postoperative complication (OR=0.77, 95% C.I. 0.70-0.85) and anesthesia-related complications (OR=0.72, 95% C.I. 0.57-0.91). This association was strongest in the youngest children (<5 years) and at children's hospitals. For pyloromyotomy patients, urban hospitals were associated with reduced odds of any complication (OR=0.43, 95% C.I. 0.24-0.75), anesthesia-related complications (OR=0.14, 95% C.I. 0.05-0.37), and duodenal perforation (OR=0.46, 95% C.I. 0.19-1.07). These associations were most significant at children's hospitals.
  
  
  CONCLUSIONS
  Postoperative outcomes appear to be improved at urban specialty hospitals relative to rural hospitals for certain common pediatric procedures. Identification of the factors driving this association may help inform resource optimization efforts in pediatric surgery.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA. Electronic address: jarodmc@u.washington.edu.
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Morgan K
authors.initials: MK
authors.lastname: Richards
authors.affiliation: Departments of Epidemiology and Global Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Stergachis
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Keith T
authors.initials: KT
authors.lastname: Oldham
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011707:Pyloric Stenosis / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Appendectomy; Outcomes; Pediatric; Pyloromyotomy; Rural; Urban