Craniosynostosis Surgery: Does Hospital Case Volume Impact Outcomes or Cost?

BACKGROUND: The relationships between hospital/surgeon characteristics and operative outcomes and cost are being scrutinized increasingly. In patients with craniosynostosis specifically, the relationship between hospital volume and outcomes has yet to be characterized. METHODS: Subjects undergoing craniosynostosis surgery between 2004 and 2015 were identified in the Pediatric Health Information System. Outcomes were compared between two exposure groups, those undergoing treatment at a high-volume institution (>40 cases per year), and those undergoing treatment at a low-volume institution (40 cases per year). Primary outcomes were any complication, prolonged length of stay, and increased total cost. RESULTS: Over 13,000 patients (n = 13,112) from 49 institutions met inclusion criteria. In multivariate regression analyses, subjects treated in high-volume centers were less likely to experience any complication (OR, 0.764; p < 0.001), were less likely to have an extended length of stay (OR, 0.624; p < 0.001), and were less likely to have increased total cost (OR, 0.596; p < 0.001). Subjects undergoing strip craniectomy in high-volume centers were also less likely to have any complication (OR, 0.708; p = 0.018) or increased total cost (OR, 0.51; p < 0.001). Subjects undergoing midvault reconstruction in high-volume centers were less likely to experience any complications (OR, 0.696; p = 0.002), have an extended length of stay (OR, 0.542; p < 0.001), or have increased total cost (OR, 0.495; p < 0.001). CONCLUSION: In hospitals performing a high volume of craniosynostosis surgery, subjects had significantly decreased odds of experiencing a complication, prolonged length of stay, or increased total cost compared with those undergoing treatment in low-volume institutions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Concerns With Entertainment-Education: Zombie Pandemic Preparedness and the Unanticipated Promotion of a Weapons Culture.

Entertainment-education has proved to be an engaging medium through which to explore health and social issues in populations. Given the popularity of the zombie theme in popular culture it is no surprise therefore that the Centers for Disease Control and Prevention adopted this theme in an effort to engage youth and young adults in emergency preparedness. However, an earlier observational study involving elementary school children based on this premise raised concerns that it may have unexpectedly promoted a focus on firearms. A randomized control study involving 89 children (average age 10.4 years) was therefore conducted to explore this possibility in more depth. One group was exposed to a natural disaster scenario, while the other group was exposed to the zombie pandemic theme. When subsequently asked to prepare emergency kit lists, participants in the zombie themed scenario were 15.84 times as likely to include firearms in their lists compared with participants who were exposed to the natural disaster scenario. Although the sample size in this study was small, it is suggested that future interventions using entertainment-education need to explore all aspects of the messages implicit in their chosen medium, rather than just focusing on one element.

A five year retrospective study of short term respiratory support outcomes for infants who received tracheostomy before one year of age.

OBJECTIVES: This study aims to describe respiratory support requirements at the time of hospital discharge for infants who undergo tracheostomy, and to determine whether certain indications for tracheostomy are significantly associated with ventilator or oxygen dependence at the time of discharge. METHODS: Retrospective chart review identified 150 patients who underwent tracheostomy before 1 year of age at a single center from 2007 to 2012 and were discharged alive. Patients were divided into groups based on primary indication for tracheostomy: chronic lung disease (CLD); cardiac; airway anomalies (e.g., tracheomalacia, subglottic stenosis); anatomic anomalies of head, neck and chest; neuro/muscular; mixed group (>1 primary indication). Chi-squared tests were used to compare respiratory support requirements at time of discharge, as well as need for supplemental oxygen. RESULTS: Of the 150 patients included in the study, three were discharged on room air alone. Of those 147 who did require some form of support at discharge, significant differences were found between groups when comparing CPAP to ventilator support. For example, of the patients with CLD, 82% were discharged on ventilator support whereas of those with a primary airway indication nearly 54% were discharged on CPAP. Significant differences were also found among groups when comparing patients discharged on room air vs. supplemental oxygen. Patients with CLD were more likely to be discharged on supplemental oxygen (p=0.001) whereas of the patients with anatomic indication 77% required no supplemental oxygen at the time of discharge. CONCLUSION: Respiratory support needs at the time of discharge for neonates who underwent tracheostomy varied significantly depending on the initial indication for tracheostomy. Information about respiratory requirements of infants who undergo tracheostomy can help clinicians counsel families and anticipate post-discharge needs.