title: Influence of hospital-level practice patterns on variation in the application of minimally invasive surgery in United States pediatric patients.
abstract: BACKGROUND
  Although disparities in access to minimally invasive surgery are thought to exist in pediatric surgical patients in the United States, hospital-level practice patterns have not been evaluated as a possible contributing factor.
  
  
  METHODS
  Retrospective cohort study using the Kids' Inpatient Database, 2012. Odds ratios of undergoing a minimally invasive compared to open operation were calculated for six typical pediatric surgical operations after adjustment for multiple patient demographic and hospital-level variables. Further adjustment to the regression model was made by incorporating hospital practice patterns, defined as operation-specific minimally invasive frequency and volume.
  
  
  RESULTS
  Age was the most significant patient demographic factor affecting application of minimally invasive surgery for all procedures. For several procedures, adjusting for individual hospital practice patterns removed race- and income-based disparities seen in performance of minimally invasive operations. Disparities related to insurance status were not affected by the same adjustment.
  
  
  CONCLUSIONS
  Variation in the application of minimally invasive surgery in pediatric surgical patients is primarily influenced by patient age and the type of procedure performed. Perceived disparities in access related to some socioeconomic factors are decreased but not eliminated by accounting for individual hospital practice patterns, suggesting that complex underlying factors influence application of advanced surgical techniques.
  
  
  METHODS
  II.
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY. Electronic address: ATrain@Kaleidahealth.org.
authors.forename: Arianne T
authors.initials: AT
authors.lastname: Train
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, Buffalo, NY.
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
authors.affiliation: Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, Buffalo, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Rothstein
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000592:standards*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013043:Specialties, Surgical; D014481:United States
keywords: Minimally invasive surgery; Pediatric surgery; Surgical disparities