Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
J Pediatr Surg
; 55(6): 1048-1052, 2020 Jun.
Article
em En
| MEDLINE
| ID: mdl-32173118
ABSTRACT
BACKGROUND:
The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. We elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.METHODS:
We used data from 49 US children's hospitals between 2007 and 2017 for the following procedures congenital diaphragmatic hernia repair (CDH), esophageal atresia and tracheoesophageal fistula repair (EA/TEF), and pull-through for Hirschsprung disease (HD). Mixed effects logistic regression modeling was used to adjust for salient patient characteristics to determine the effect of HHI on in-hospital mortality, condition-specific one-year re-operation, and one-year unplanned readmissions.RESULTS:
A total of 2270 infants were identified who underwent surgery for the three conditions of interest. On multivariable analysis, increasing HHI was not associated with differences in mortality or condition-specific re-operation within the first year. A decrease in the number of unplanned readmissions at highly concentrated centers was seen for HD (RR 0.8 CI (0.69-0.97), pâ¯=â¯0.02) and CDH (RR 0.4 CI (0.28-0.71), pâ¯<â¯0.001).CONCLUSIONS:
Pediatric surgical specialization did not affect mortality or condition-specific re-operation. However, it did decrease the number of unplanned readmissions following CDH repairs and pull-throughs for HD. STUDYDESIGN:
Retrospective Cohort Study. LEVEL OF EVIDENCE Level II.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Especialidades Cirúrgicas
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Fístula Traqueoesofágica
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Atresia Esofágica
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Hérnias Diafragmáticas Congênitas
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Cirurgiões
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Doença de Hirschsprung
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article