title: Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis.
abstract: BACKGROUND
  This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes.
  
  
  METHODS
  A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates.
  
  
  RESULTS
  23 hospitals with 618 patients undergoing NEC-related surgical intervention were included. Overall mortality rate was 22.5%. There were no significant differences in the number of NICU beds (p = 0.135) or NICU intensivists (p = 0.469) between high and low volume hospitals. Following risk adjustment, no difference in mortality rate was observed between high and low volume hospitals respectively (24.0% vs. 20.3%, p = 0.555).
  
  
  CONCLUSIONS
  Our observation that neonates with NEC treated at low-volume centers have no increased risk of mortality may be explained by similar availability of NICU and intensivists resources across hospitals.
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
authors.forename: Adrienne N
authors.initials: AN
authors.lastname: Cobb
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA.
authors.forename: Yee M
authors.initials: YM
authors.lastname: Wong
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.affiliation: One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Blanco
authors.affiliation: One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Ezure
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; Loyola University Medical Center, Department of Pediatrics, Maywood, IL, USA.
authors.forename: Heather N
authors.initials: HN
authors.lastname: Paddock
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA. Electronic address: paul.kuo@luhs.org.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Loyola University Medical Center, Department of Surgery, Maywood, IL, USA; One:MAP Section of Surgical Analytics, Department of Surgery, Loyola University Chicago, USA.
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
mesh_terms: D003430:Cross-Sectional Studies; D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000601:surgery*; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D000078329:Workforce
keywords: Care delivery microenvironment; NEC; Necrotizing enterocolitis; Pediatric surgery; Surgical outcomes