title: Is there a relationship between hospital volume and patient outcomes in gastroschisis repair?
abstract: OBJECTIVE
  Given the well-established relationship between surgical volume and outcomes for many surgical procedures, we examined whether the same relationship exists for gastroschisis closure.
  
  
  METHODS
  We conducted a retrospective analysis of infants who underwent gastroschisis closure between 1999 and 2007 using a California birth-linked cohort. Hospitals were divided into terciles based on the number of gastroschisis closures performed annually. Using regression techniques, we examined the effects of hospital volume on patient mortality and length of stay while controlling for patient and hospital confounders.
  
  
  RESULTS
  We identified 1537 infants who underwent gastroschisis repair at 55 hospitals, 4 of which were high-volume and 42 of which were low-volume. The overall in-hospital mortality rate was 4.8% and the median length of stay was 46.5days. After controlling for other factors, patients treated at high-volume hospitals had significantly lower odds of inpatient mortality (OR 0.40; 95% CI 0.21, 0.76). There was a near-significant trend towards shorter hospital length of stay at highvolume hospitals (p=0.066).
  
  
  CONCLUSIONS
  Patients who undergo gastroschisis closure at high-volume hospitals in California experience lower odds of in-hospital mortality compared to those treated at low-volume hospitals. These findings offer initial evidence to support policies that limit the number of hospitals providing complex newborn surgical care.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System. Electronic address: gsacks@mednet.ucla.edu.
authors.forename: Greg D
authors.initials: GD
authors.lastname: Sacks
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System; Department of Surgery, University of California, San Francisco.
authors.forename: Jesus G
authors.initials: JG
authors.lastname: Ulloa
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Shew
mesh_terms: D002140:California; D005260:Female; D020139:Gastroschisis / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gastroschisis; Newborn surgery; Regionalization; Volume outcome