title: National Analysis of 2454 Pediatric Moyamoya Admissions and the Effect of Hospital Volume on Outcomes.
abstract: Comprehensive multicenter data on treatment of pediatric moyamoya in the United States is lacking. We sought to identify national trends in the diagnosis and treatment of this disease.
  
  
  
  A total of 2454 moyamoya admissions from 1997 to 2012 were identified from the Kids Inpatient Database. Demographics, inpatient costs, interventions, and discharge status were analyzed. Admissions with and without surgical revascularization were reviewed separately. The effect of hospital moyamoya volume on outcomes was analyzed by multivariate regression analysis.
  
  
  
  Care of moyamoya patients has been concentrating at high-volume centers during the past 12 years. Among moyamoya admission without surgical revascularization, high-volume hospitals show no difference in length of stay, cost, or complications compared with low-volume centers. However, low-volume hospitals have more nonroutine discharges (odds ratio, 2.32; P=0.0005) and inpatient deaths (odds ratio, 12.7; P=0.02) when no revascularization was performed. In contrast, among admissions with surgical revascularization, high-volume centers had decreased length of stay (4.7 versus 6.2 days; P=0.004), reduced cost ($88 000 versus $138 000; P<0.0001), and no increase in complications (P=0.29) compared with low-volume centers. Admissions with revascularization to low-volume hospitals also had increased likelihood of nonroutine discharge (odds ratio, 8.23; P=0.02) compared with high-volume centers.
  
  
  
  This is the largest study of US pediatric moyamoya admissions to date. These data demonstrate that volume correlates with outcome, indicating high-volume centers provide significantly improved care and reduced mortality in pediatric moyamoya patients, with the most marked benefit observed in admissions for surgical revascularization.
authors.affiliation: From the Department of Neurosurgery, University of Florida, Gainesville (W.L.T.); Clinical Effectiveness, Harvard School of Public Health (W.L.T.) and Department of Surgery, Harvard Medical School (R.M.S., E.R.S.), Harvard University, Cambridge, MA; and Department of Neurosurgery, Children's Hospital Boston, MA (R.M.S., E.R.S.). wlt@ufl.edu.
authors.forename: W Lee
authors.initials: WL
authors.lastname: Titsworth
authors.affiliation: From the Department of Neurosurgery, University of Florida, Gainesville (W.L.T.); Clinical Effectiveness, Harvard School of Public Health (W.L.T.) and Department of Surgery, Harvard Medical School (R.M.S., E.R.S.), Harvard University, Cambridge, MA; and Department of Neurosurgery, Children's Hospital Boston, MA (R.M.S., E.R.S.).
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.affiliation: From the Department of Neurosurgery, University of Florida, Gainesville (W.L.T.); Clinical Effectiveness, Harvard School of Public Health (W.L.T.) and Department of Surgery, Harvard Medical School (R.M.S., E.R.S.), Harvard University, Cambridge, MA; and Department of Neurosurgery, Children's Hospital Boston, MA (R.M.S., E.R.S.).
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D002548:Cerebral Revascularization / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009072:Moyamoya Disease / Q000601:surgery / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: high-volume hospitals; inpatients; length of stay; moyamoya disease; stroke