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Georgeades C, Bodnar C, Bergner C, Van Arendonk KJ. Association of complicated appendicitis with geographic and socioeconomic measures in children. Surgery 2024:S0039-6060(24)00563-4. [PMID: 39232975 DOI: 10.1016/j.surg.2024.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/20/2024] [Accepted: 07/29/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Complicated appendicitis, considered a marker of delay in accessing surgical care among children, has been inconsistently associated with race, socioeconomic status, insurance type, rurality, and distance to care. This statewide assessment measured factors associated with complicated appendicitis while overcoming limitations of prior work, namely, selection bias and use of inexact socioeconomic status measures. METHODS Children (<18 years) undergoing appendectomy for appendicitis in Wisconsin from 2018 to 2021 were identified in the Wisconsin Hospital Association database. Patient residence and hospital locations were used to determine rurality, travel distances, and socioeconomic status as measured by Area Deprivation Index, Child Opportunity Index, Community Need Index, and county-level poverty rates. Multivariable logistic regression was used to assess factors associated with complicated appendicitis. RESULTS Among 5,881 children undergoing appendectomy, 1,375 (23.4%) had complicated appendicitis. Adjusting for other variables, complicated appendicitis was associated with younger age (adjusted odds ratio 0.90 per year increase); Hispanic White race/ethnicity (adjusted odds ratio 1.40-1.63); distance to the hospital where surgery was performed (adjusted odds ratio 1.16-1.17 per 10-mile increase); and very low Child Opportunity Index (adjusted odds ratio 1.29), Community Need Index (adjusted odds ratio 1.20 per 1-score increase), and county-level poverty (adjusted odds ratio 1.02 per 1% increase). Insurance type, rurality, and Area Deprivation Index were not associated with complicated appendicitis. Residential county-level complicated appendicitis rates (0.0%-50.0%) had moderate correlation to pediatric county-level poverty rates (rs=0.43). CONCLUSION Complicated appendicitis was associated with Child Opportunity Index, Community Need Index, and county-level poverty but not insurance type, rurality, or Area Deprivation Index. There was geographic variability in complicated appendicitis rates, with modest correlation to county-level poverty. Targeted interventions among Hispanic populations and those with travel- and socioeconomic status-related barriers to care may be beneficial in preventing complicated appendicitis among children.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Catherine Bodnar
- Department of Pathology and Laboratory Medicine, University of Wisconsin Health/University of Wisconsin-Hospital and Clinics, Madison, WI
| | - Carisa Bergner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Department of Surgery, Nationwide Children's Hospital, Columbus, OH. https://twitter.com/KyleVanArendonk
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Bhatnagar A, Mackman S, Van Arendonk KJ, Thalji SZ. Associations between Hospital Setting and Outcomes after Pediatric Appendectomy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1908. [PMID: 38136110 PMCID: PMC10741462 DOI: 10.3390/children10121908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Prior studies of associations between hospital location and outcomes for pediatric appendectomy have not adjusted for significant differences in patient and treatment patterns between settings. This was a cross-sectional analysis of pediatric appendectomies in the 2016 Kids' Inpatient Database (KID). Weighted multiple linear and logistic regression models compared hospital location (urban or rural) and academic status against total admission cost (TAC), length of stay (LOS), and postoperative complications. Patients were stratified by laparoscopic (LA) or open (OA) appendectomy. Among 54,836 patients, 39,454 (73%) were performed at an urban academic center, 11,642 (21%) were performed at an urban non-academic center, and 3740 (7%) were performed at a rural center. LA was utilized for 49,011 (89%) of all 54,386 patients: 36,049 (91%) of 39,454 patients at urban academic hospitals, 10,191 (87%) of 11,642 patients at urban non-academic centers, and 2771 (74%) of 3740 patients at rural centers (p < 0.001). On adjusted analysis, urban academic centers were associated with an 18% decreased TAC (95% CI -0.193--0.165; p < 0.001) despite an 11% increased LOS (95% CI 0.087-0.134; p < 0.001) compared to rural centers. Urban academic centers were associated with a decreased odds of complication among patients who underwent LA (OR 0.787, 95% CI 0.650-0.952) but not after OA. After adjusting for relevant patient and disease-related factors, urban academic centers were associated with lower costs despite longer lengths of stay compared to rural centers. Urban academic centers utilized LA more frequently and were associated with decreased odds of postoperative complications after LA.
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Affiliation(s)
| | - Sean Mackman
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Kyle J. Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Sam Z. Thalji
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
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3
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Marquart J, Salazar JH, Bergner C, Farazi M, Van Arendonk KJ. Location of Treatment Among Infants Requiring Complex Surgical Care. J Surg Res 2023; 292:214-221. [PMID: 37634425 DOI: 10.1016/j.jss.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/13/2023] [Accepted: 07/01/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Rural children have worse health outcomes compared to urban children. One mechanism for this finding may be decreased access to specialized care at children's hospitals. The objective of this study was to evaluate the hospital types where complex surgical care in infants is performed nationally. METHODS This study examined infants (<1 y old) in the Kids' Inpatient Database from 2009 to 2019 who underwent surgery for one of the following conditions: esophageal atresia, gastroschisis, omphalocele, Hirschsprung disease, anorectal malformation, pyloric stenosis, small bowel atresia, congenital diaphragmatic hernia, and necrotizing enterocolitis. The relationship between patient residence (rural versus urban) and location of surgical care (children's hospital versus other) was compared in relation to other covariates using multivariable logistic regression models. RESULTS Among 29,185 infants undergoing these operations, 16.0% lived in a rural area. Rural infants were more frequently White (64.8% versus 43.4% P < 0.001), from the lowest two income quartiles (86.5% versus 52.0%, P < 0.001), and from the South or Midwest regions (P < 0.001). Surgical care was predominantly (94.1%) provided at urban teaching hospitals but frequently not at children's hospitals, especially among rural infants. After adjusting for other covariates, rural infants were significantly less likely to undergo care at a children's hospital for both 2009 (adjusted odds ratio 0.66, P < 0.001) and 2012-2019 (adjusted odds ratio 0.78, P < 0.001). CONCLUSIONS A sizable portion of complex surgical care in infants is performed outside children's hospitals, especially among those from rural areas. Further work is necessary to ensure adequate access to children's hospitals for rural children.
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Affiliation(s)
- John Marquart
- Department of Surgery, Pediatric General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jose H Salazar
- Department of Surgery, Pediatric General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carisa Bergner
- Department of Surgery, Pediatric General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manzur Farazi
- Department of Surgery, Pediatric General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyle J Van Arendonk
- Department of Surgery, Pediatric General Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Naser AY, Al-shehri H. Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales. J Multidiscip Healthc 2023; 16:3545-3554. [PMID: 38024128 PMCID: PMC10661900 DOI: 10.2147/jmdh.s441247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To analyze the hospitalization patterns associated with postprocedural complications among the pediatric population in England and Wales over the past two decades. Patients and Methods This was an ecological study using hospital admission data extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Postprocedural complications related hospital admissions were identified using the 10th version of the International Statistical Classification of Diseases (ICD) system (D78, E89, H59, H95, J95, L76, M96, and N99). Results The rate of hospital admissions declined by 2.1% [from 8.32 (95% CI 7.75-8.88) per 100,000 persons in 1999 to 8.15 (95% CI 7.61-8.68) per 100,000 persons in 2020, p>0.05]. The primary reasons for hospital admissions associated with postprocedural complications were related to the respiratory system, genitourinary system, and ear and mastoid process, constituting 43.0%, 23.8%, and 23.0% of cases, respectively. Conclusion The trend of postprocedural complications among the pediatric population has been stable in the past two decades. Continuous monitoring of the hospitalization pattern for this type of complication is important due to advancements in healthcare provision and to improve patient care and safety. Future studies are needed to examine gender-based differences related to postprocedural complications and identify important preventable risk factors.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Al-shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Gadepalli SK, Leraas HJ, Flynn-O'Brien KT, Van Arendonk KJ, Hall M, Tracy ET, Ricca RL, Goldin AB, Ehrlich PF. Changing Landscape of Routine Pediatric Surgery for Rural and Urban Children: A Report From the Child Health Evaluation of Surgical Services (CHESS) Group. Ann Surg 2023; 278:530-537. [PMID: 37497661 DOI: 10.1097/sla.0000000000005990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To describe the changes to routine pediatric surgical care over the past 2 decades for children living in urban and rural environments. BACKGROUND A knowledge gaps exists regarding trends in the location where routine pediatric surgical care is provided to children from urban and rural environments over time. METHODS Children (age 0-18) undergoing 7 common surgeries were identified using State Inpatient Databases (SID, 2002-2017). Rural-Urban Commuting Area codes were used to classify patient and hospital zip codes. Multivariable regression models for distance traveled >60 miles and transfer status were used to compare rural and urban populations, adjusting for year, age, sex, race, and insurance status. RESULTS Among 143,467 children, 13% lived in rural zip codes. The distance traveled for care increased for both rural and urban children for all procedures but significantly more for the rural cohort (eg, 102% vs 30%, P <0.001, cholecystectomy). Transfers also increased for rural children (eg, transfers for appendectomy increased from 1% in 2002 to 23% in 2017, P <0.001). Factors associated with the need to travel >60 miles included year [adjusted odds ratio (aOR)=2.18, 95% CI: 1.94-2.46: 2017 vs 2002], rural residence (aOR=6.55, 95% CI: 6.11-7.01), age less than 5 years (aOR=2.17, 95% CI: 1.92-2.46), and Medicaid insurance (aOR=1.35, 95% CI: 1.26-1.45). Factors associated with transfer included year (aOR=5.77, 95% CI: 5.26-6.33: 2017 vs 2002), rural residence (aOR=1.47, 95% CI: 1.39-1.56), age less than 10 years (aOR=2.34, 95% CI: 2.15-2.54), and Medicaid insurance (aOR=1.49, 95% CI: 1.42-1.46). CONCLUSION Rural children, younger age, and those on Medicaid disproportionately traveled greater distances and were more frequently transferred for common pediatric surgical procedures.
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Affiliation(s)
- Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Harold J Leraas
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | | | - Kyle J Van Arendonk
- Department of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Robert L Ricca
- Division of Pediatric Surgery, University of South Carolina, Prisma Health Upstate, Greenville Memorial Hospital, Greenville, SC
| | - Adam B Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Parikh RM, Ata A, Edwards MJ. A Contemporary Review of Surgical Approach and Outcomes in Pediatric Hypertrophic Pyloric Stenosis. J Surg Res 2023; 285:142-149. [PMID: 36669393 DOI: 10.1016/j.jss.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/02/2022] [Accepted: 12/25/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In order to define optimal resources and outcome standards for infant pyloromyotomy, we sought to perform a contemporary analysis of surgical approach (laparoscopic versus open) and outcomes. METHODS The National Surgical Quality Improvement Project Pediatrics Participant Use File (NSQIP PUF) was queried from 2016 to 2020. Utilization of laparoscopy was trended over time. Complication rates and length of stay were compared by operative approach. RESULTS 9752 pyloromyotomies were included in the analysis. The utilization of laparoscopy steadily increased over the study time period (66% to 79%) and was associated with a shorter operative time. On multivariate regression, the utilization of laparoscopy was associated with a lower risk of overall complications, length of stay, and superficial surgical site infections. Overall complication rates were lower than previously reported (2.02%). The most common complication was superficial infection (1.2%). CONCLUSIONS In facilities reporting to pediatric National Quality Improvement Project, utilization of laparoscopy has steadily increased, and complication rates are lower than previously reported. Complication rates and length of stay were lower with the laparoscopic approach in this contemporary cohort. These results offer benchmarks for quality improvement initiatives. The laparoscopic approach should be standard in facilities performing this procedure.
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Affiliation(s)
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Mary J Edwards
- Department of Surgery, Albany Medical Center, Albany, New York.
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7
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Georgeades C, Farazi MR, Gainer H, Flynn-O'Brien KT, Leys CM, Gourlay D, Van Arendonk KJ. Distribution of acute appendicitis care in children: A statewide assessment of the surgeons and facilities providing surgical care. Surgery 2023; 173:765-773. [PMID: 36244816 DOI: 10.1016/j.surg.2022.06.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pediatric appendicitis is managed by general and pediatric surgeons at both children's hospitals and non-children's hospitals. A statewide assessment of surgeons and facilities providing appendicitis care was performed to identify factors associated with location of surgical care. METHODS Children aged <18 years undergoing appendectomy for appendicitis in Wisconsin from 2018-2020 were identified through the International Classification of Diseases, 10th revision, and Current Procedural Terminology codes using Wisconsin Hospital Association data. Patient residence and hospital locations were used to determine travel distance, rurality, and neighborhood-level socioeconomic status. RESULTS Among 3,604 children with appendicitis, 36.0% and 12.8% had an appendectomy at 2 major children's hospitals and 4 other children's hospitals, respectively, and 51.2% had an appendectomy at 99 non-children's hospitals. Pediatric surgeons performed 76.1% of appendectomies at children's hospitals and 2.9% at non-children's hospitals. Only 32.2% of patients received care at the hospital closest to their homes. Non-children's hospitals disproportionally cared for older, non-Hispanic White, and privately insured children, those with uncomplicated appendicitis, and those living in rural areas, in mid-socioeconomic status neighborhoods, and greater distances from children's hospitals (all P < .001). After multivariable adjustment, receipt of care at children's hospitals was associated with younger age, minority race, complicated appendicitis, shorter distance to children's hospitals, and urban residence. CONCLUSION Over half of surgical care for pediatric appendicitis occurred at non-children's hospitals, especially among older children and those living in rural areas far from children's hospitals. Future work is necessary to determine which children benefit most from care at children's hospitals and which can safely receive care at non-children's hospitals to avoid unnecessary time and resource utilization associated with travel to children's hospitals.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Manzur R Farazi
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Hailey Gainer
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Charles M Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - David Gourlay
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Cockrell H, Barry D, Dick A, Greenberg S. Geographic access to care and pediatric surgical outcomes. Am J Surg 2023; 225:903-908. [PMID: 36803619 DOI: 10.1016/j.amjsurg.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/13/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Rurality and distance traveled for healthcare are associated with worse pediatric health indicators. METHODS We retrospectively analyzed patients ages 0-21 at a quaternary pediatric surgical facility with a large rural catchment area between 1/1/2016-12/31/2020. Patient addresses were designated as metropolitan or non-metropolitan. 60- and 120-min driving rings from our institution were calculated. Logistic regression assessed the effect of rurality and distance traveled for care on postoperative mortality and serious adverse events (SAE). RESULTS Among 56,655 patients, 84.3% were from metropolitan areas, 8.4% from non-metropolitan areas, and 7.3% could not be geocoded. 64% were within 60-min driving and 80% within 120-min. On univariable regression, patients living >120-min experienced 59% (95% CI: 1.09, 2.30) increased odds of mortality and 97% (95% CI: 1.84, 2.12) increased odds of SAE compared to those <60-min. Non-metropolitan patients experienced 38% (95% CI: 1.26, 1.52) increased odds of a serious postoperative event compared to metropolitan patients. DISCUSSION Efforts to improve geographic access to pediatric care are needed to mitigate the impact of rurality and travel time on inequitable surgical outcomes.
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Affiliation(s)
- Hannah Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Dwight Barry
- Department of Clinical Analytics, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Andre Dick
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA, 98195, USA; Division of Transplant Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Sarah Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA, 98195, USA
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Buss R, SenthilKumar G, Bouchard M, Bowder A, Marquart J, Cooke-Barber J, Vore E, Beals D, Raval M, Rich BS, Goldstein S, Van Arendonk K. Geographic barriers to children's surgical care: A systematic review of existing evidence. J Pediatr Surg 2022; 57:107-117. [PMID: 34963510 DOI: 10.1016/j.jpedsurg.2021.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ensuring that children have access to timely and appropriate surgical care is a vital component of comprehensive pediatric care. This study systematically reviews the existing evidence related to geographic barriers in children's surgery. METHODS Medline and Scopus databases were searched for any English language studies that examined associations between geographic burden (rural residence or distance to care) and a quantifiable outcome within pediatric surgical subspecialties. Two independent reviewers extracted data from each study. RESULTS From 6331 studies screened, 22 studies met inclusion criteria. Most studies were retrospective analyses and conducted in the U.S. or Canada (14 and three studies, respectively); five were conducted outside North America. In transplant surgery (seven studies), greater distance from a transplant center was associated with higher waitlist mortality prior to kidney and liver transplantation, although graft outcomes were generally similar. In congenital cardiac surgery (five studies), greater travel was associated with higher neonatal mortality and older age at surgery but not with post-operative outcomes. In general surgery (eight studies), rural residence was associated with increased rates of perforated appendicitis, higher frequency of negative appendectomy, and increased length of stay after appendectomy. In orthopedic surgery (one study), rurality was associated with decreased post-operative satisfaction. No evidence for disparate outcomes based upon distance or rurality was identified in neurosurgery (one study). CONCLUSIONS Substantial evidence suggests that geographic barriers impact the receipt of surgical care among children, particularly with regard to transplantation, congenital cardiac surgery, and appendicitis.
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Affiliation(s)
- Radek Buss
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States
| | - Gopika SenthilKumar
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States
| | - Megan Bouchard
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Chicago, IL 60611, United States
| | - Alexis Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States
| | - John Marquart
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States
| | - Jo Cooke-Barber
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave. ML 2023, Cincinnati, OH 45229, United States
| | - Emily Vore
- Department of Surgery, Marshall University Medical Center, 1600 Medical Center Drive, Suite 2500, Huntington, WV 25701, United States
| | - Daniel Beals
- Department of Surgery, Marshall University Medical Center, 1600 Medical Center Drive, Suite 2500, Huntington, WV 25701, United States
| | - Mehul Raval
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Chicago, IL 60611, United States
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, 450 Lakeville Rd, North New Hyde Park, NY 11042, United States
| | - Seth Goldstein
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Chicago, IL 60611, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, United States.
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10
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Brock R, Chu A, Lu S, Brindle ME, Somayaji R. Postoperative complications after gastrointestinal pediatric surgical procedures: outcomes and socio-demographic risk factors. BMC Pediatr 2022; 22:358. [PMID: 35733099 PMCID: PMC9215078 DOI: 10.1186/s12887-022-03418-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several socio-demographic characteristics are associated with complications following certain pediatric surgical procedures. In this comprehensive study, we sought to determine socio-demographic risk factors and resource utilization of children with complications after common pediatric surgical procedures. METHODS We performed a population-based cohort study utilizing the 2016 Healthcare Cost and Use Project Kids' Inpatient Database (KID) to identify and characterize pediatric patients (age 0-21 years) in the United States with common inpatient pediatric gastrointestinal surgical procedures: appendectomy, cholecystectomy, colonic resection, pyloromyotomy and small bowel resection. Multivariable logistic regression modeling was used to identify socio-demographic predictors of postoperative complications. Length of stay and hospitalization costs for patients with and without postoperative complications were compared. RESULTS A total of 66,157 pediatric surgical hospitalizations were identified. Of these patients, 2,009 had postoperative complications. Male sex, young age, African American and Native American race and treatment in a rural hospital were associated with significantly greater odds of postoperative complications. Mean length of stay was 4.58 days greater and mean total costs were $11,151 (US dollars) higher in the complication cohort compared with patients without complications. CONCLUSIONS Postoperative complications following inpatient pediatric gastrointestinal surgery were linked to elevated healthcare-related expenditure. The identified socio-demographic risk factors should be considered in the risk stratification before pediatric surgical procedures. Targeted interventions are required to reduce preventable complications and surgical disparities.
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Affiliation(s)
- Robert Brock
- Department of Pediatric and Adolescent Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Angel Chu
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shengjie Lu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Elizabeth Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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11
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Sogbodjor LA, Singleton G, Davenport M, Walker S, Moonesinghe SR. Quality metrics for emergency abdominal surgery in children: a systematic review. Br J Anaesth 2021; 128:522-534. [PMID: 34895715 DOI: 10.1016/j.bja.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is variation in care quality and outcomes for children undergoing emergency abdominal surgery, such as appedectomy. Addressing this requires paediatric-specific quality metrics. The aim of this study was to identify perioperative structure and process measures that are associated with improved outcomes for these children. METHODS We performed a systematic review searching MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar for articles published between January 1, 1980 and September 29, 2020 about the perioperative care of children undergoing emergency abdominal surgery. We also conducted secondary searching of references and citations, and we included international professional publications. RESULTS We identified and analysed 383 peer-reviewed articles and 18 grey literature publications. High-grade evidence pertaining to the perioperative care of this patient group is limited. Most of the evidence available relates to improving diagnostic accuracy using preoperative blood testing, imaging, and clinical decision tools. Processes associated with clinical outcomes include time lapse between time of presentation or initial assessment and surgery, and the use of particular analgesia and antibiotic protocols. Structural factors identified include hospital and surgeon caseload and the use of perioperative care pathways. CONCLUSIONS This review summarises the structural and process measures associated with outcome in paediatric emergency abdominal surgery. Such measures provide a means of evaluating care and identifying areas of practice that require quality improvement, especially in children with appendicitis. CLINICAL TRIAL REGISTRATION PROSPERO CRD42017055285.
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Affiliation(s)
- Lisa A Sogbodjor
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Georgina Singleton
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Suellen Walker
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond St Institute of Child Health, London, UK
| | - S Ramani Moonesinghe
- Centre for Perioperative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK; UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK
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Seqsaqa M, Rozeik AE, Khalifa M, Ashri HNA. Geographic influence on postoperative complications in children with complicated appendicitis: a single center study. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute appendicitis is one of the most common abdominal emergencies in children. Complicated appendicitis is much more common in pediatric age group than in adults due to probability of delay in diagnosis or misdiagnosis. Geographic status has an influence on the clinical course of such surgical cases. This prospective comparative study was conducted at the pediatric surgery department in our hospital in Egypt during the period from December 2018 to August 2019, aiming to find the relation between residence of patients and occurrence of post-operative complications among patients in Sharkia Governorate, Egypt. Patients were divided into two groups: rural and urban. Data recorded included demographic data, preoperative assessment, operative findings, postoperative course, postoperative complications, and follow-up.
Results
Sixty patients were included in the study, 32 of them were from rural areas, and 28 were from urban areas. There was no significant difference between them regarding demographics. Duration of symptoms was significantly longer with rural group (3.7 ± 1.4 vs. 3.07 ± 0.92 days). Length of hospital stay was significantly longer with the rural group (4.7 ± 1.7 vs. 4.7 ± 1.7 days). The rate of wound infection was significantly higher with the rural group (34.37% vs. 10.7%), while other postoperative complications were increased with rural group, but that was not statistically significant. The regularity of follow-up was higher with the urban group.
Conclusions
Children with complicated appendicitis from rural areas are at higher risk for occurrence of postoperative complications and poor outcome, with less regularity in follow-up. This is because of many obstacles they faced, including difficulties of transportation, insufficient medical services, and low socioeconomic and educational statuses.
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Development of a Standardized Program for the Collaboration of Adult and Children's Surgeons. J Surg Res 2021; 269:36-43. [PMID: 34517187 DOI: 10.1016/j.jss.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) are often required for disease processes requiring interventions that fall outside the customary practice of children's surgeons. Formal models to describe or evaluate these practices are lacking. METHODS HSOs within a CH/LH were identified. Principles of systems-engineering were used to develop a standardized model (Children's Hybrid Enhanced Surgical Services [CHESS]) to describe and evaluate HSOs. Face validity was established via unstructured interviews of CH leaders and HSO surgeons. Areas for improved system-wide standardization and programmatic development were identified. RESULTS HSOs were identified in collaboration with adult bariatric, minimally invasive, advanced endoscopic, endocrine, thoracic, and orthopedic trauma surgical services. The CHESS framework encompassed: 1) quality improvement metrics, 2) credentialing and oversight, 3) transitions of care, 4) pediatric family-centered care, 5) maintenance of the cycle of expertise, 6) continuing medical education, 7) scholarship. While HSOs fulfilled the majority of aforementioned programmatic domains across all six HSO-providing services, areas for improvement included maintaining a cycle of expertise (33%), quality improvement metrics (50%), and pediatric family-centered care (66%). Additional noted advantages included faster translation of adult innovation to pediatric care and facilitation of emergency interdisciplinary care. CONCLUSION Formal evaluation of HSOs is necessary to standardize and improve the quality of children's surgical care. Development of a structured framework such as CHESS addresses gaps in quality oversight and provides a basis for performance improvement, patient safety, and programmatic development.
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Muffly MK, Honkanen A, Scheinker D, Wang TNY, Saynina O, Singleton MA, Wang CJ, Sanders L. Hospitalization Patterns for Inpatient Pediatric Surgery and Procedures in California: 2000–2016. Anesth Analg 2019; 131:1070-1079. [DOI: 10.1213/ane.0000000000004552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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The Impact of Sociodemographic and Hospital Factors on Length of Stay Before and After Pyloromyotomy. J Surg Res 2019; 239:1-7. [DOI: 10.1016/j.jss.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 11/23/2018] [Accepted: 01/03/2019] [Indexed: 12/27/2022]
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Flynn-O’Brien KT, Richards MK, Wright DR, Rivara FP, Haaland W, Thompson L, Oldham K, Goldin A. Health outcomes and the healthcare and societal cost of optimizing pediatric surgical care in the United States. J Pediatr Surg 2019; 54:621-627. [PMID: 30598246 PMCID: PMC6511280 DOI: 10.1016/j.jpedsurg.2018.10.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/21/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children's Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program. METHODS All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers. RESULTS 8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario. CONCLUSION Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children's surgical care in the United States. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Katherine T. Flynn-O’Brien
- Department of Surgery, Children’s Hospital of Wisconsin, Division of Pediatric Surgery, Fellow, Pediatric Surgery, 999 North 92nd Street, C320, Milwaukee, WI 53226, 505.948.0220,
| | - Morgan K. Richards
- Department of Surgery, Children’s Healthcare of Atlanta, Division of Pediatric Surgery, Fellow, Pediatric Surgery, 1405 Clifton Rd NE, Atlanta, GA 30322, 206.369.8387,
| | - Davene R. Wright
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Assistant Professor, Division of General Pediatrics, 2001 Eighth Ave, Suite 400, Seattle, WA 98121 USA, 206-884-8241,
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Professor, Division of General Pediatrics, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 98104 USA, 206-744-9449,
| | - Wren Haaland
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, 2001 Eighth Ave, Suite 400, Seattle, WA 98121, USA.
| | - Leah Thompson
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Keith Oldham
- Children's Hospital of Wisconsin, Medical College of Wisconsin, 999 North 92(nd) Street, C320, Milwaukee, WI 53226.
| | - Adam Goldin
- Department of Surgery, Seattle Children's Hospital, Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Department of Surgery, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Tom CM, Friedlander S, Sakai-Bizmark R, Shekherdimian S, Jen H, DeUgarte DA, Lee SL. Outcomes and costs of pediatric appendectomies at rural hospitals. J Pediatr Surg 2019; 54:103-107. [PMID: 30389148 DOI: 10.1016/j.jpedsurg.2018.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE Despite policy efforts to support rural hospitals, little is known about the quality and safety of pediatric surgical care in geographically remote areas. Our aim was to determine the outcomes and costs of appendectomies at rural hospitals. METHODS The Kids' Inpatient Database (2003-2012) was queried for appendectomies in children <18 years at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), cost) were analyzed with bivariate and multivariable regression analysis. RESULTS Rural hospitals performed 13.6% of appendectomies. On multivariable analysis, rural hospitals were associated with higher negative appendectomy rates (OR 1.49, 95% CI 1.39-1.60, p < 0.001), decreased appendiceal perforation rates (OR 0.86, 95% CI 0.83-0.89, p < 0.001), less laparoscopy use (OR 0.48, 95% CI 0.47-0.50, p < 0.001), higher complication rates (OR 1.29, 95% CI 1.19-1.39, p < 0.001), shorter LOS (IRR 0.90, 95% CI 0.89-0.91, p < 0.001), and slightly increased costs (exponentiated log$ 1.02, 95% CI 1.01-1.02, p < 0.001) CONCLUSIONS: Rural hospitals care for fewer patients with advanced appendicitis but are associated with higher negative appendectomy rates, lower laparoscopy use, and higher complication rates. Additional studies are needed to identify factors that drive this disparity to improve the quality of pediatric surgical care in rural settings. TYPE OF STUDY Treatment/Cost Study (Outcomes). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Cynthia M Tom
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA
| | - Scott Friedlander
- Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Rie Sakai-Bizmark
- Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Shant Shekherdimian
- Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA
| | - Howard Jen
- Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA
| | - Daniel A DeUgarte
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA; Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA
| | - Steven L Lee
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA; Division of Pediatric Surgery, UCLA, 10833 Le Conte Ave, Box 709818, Los Angeles, CA 90095, USA.
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Tom CM, Howell EC, Won RP, Friedlander S, Sakai-Bizmark R, de Virgilio C, Lee SL. Assessing outcomes and costs of appendectomies performed at rural hospitals. Am J Surg 2018; 217:1102-1106. [PMID: 30389118 DOI: 10.1016/j.amjsurg.2018.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of our study was to assess the outcomes and costs of appendectomies performed at rural and urban hospitals. METHODS The National Inpatient Sample (2001-2012) was queried for appendectomies at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), and cost) were analyzed. RESULTS Rural patients were more likely to be older, male, white, and have Medicaid or no insurance. Rural hospitals were associated with higher negative appendectomy rates (OR = 1.26,95%CI = 1.18-1.34,p < 0.01), less laparoscopy use (OR = 0.65,95%CI = 0.58-0.72,p < 0.01), and slightly shorter LOS (OR = 0.98,95%CI = 0.97-0.99,p < 0.01). There was no consistent association with perforated appendicitis and no difference in complications or costs after adjusting for hospital volume. Yearly trends showed a significant increase in the cases utilizing laparoscopy each year at rural hospitals. CONCLUSIONS Rural appendectomies are associated with increased negative appendectomy rates and less laparoscopy use with no difference in complications or costs compared to urban hospitals.
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Affiliation(s)
- Cynthia M Tom
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA
| | - Erin C Howell
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA
| | - Roy P Won
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA
| | - Scott Friedlander
- Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Rie Sakai-Bizmark
- Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Christian de Virgilio
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Steven L Lee
- Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 461, Torrance, CA, 90502, USA; Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA, 90502, USA.
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Kvasnovsky CL, Lumpkins K, Diaz JJ, Chun JY. Emergency pediatric surgery: Comparing the economic burden in specialized versus nonspecialized children's centers. J Pediatr Surg 2018. [PMID: 29525274 DOI: 10.1016/j.jpedsurg.2018.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The American College of Surgeons has developed a verification program for children's surgery centers. Highly specialized hospitals may be verified as Level I, while those with fewer dedicated resources as Level II or Level III, respectively. We hypothesized that more specialized children's centers would utilize more resources. STUDY DESIGN We performed a retrospective study of the Maryland Health Services Cost Review Commission (HSCRC) database from 2009 to 2013. We assessed total charge, length of stay (LOS), and charge per day for all inpatients with an emergency pediatric surgery diagnosis, controlling for severity of illness (SOI). Using published resources, we assigned theoretical level designations to each hospital. RESULTS Two hospitals would qualify as Level 1 hospitals, with 4593 total emergency pediatric surgery admissions (38.5%) over the five-year study period. Charges were significantly higher for children treated at Level I hospitals (all P<0.0001). Across all SOI, children at Level I hospitals had significantly longer LOS (all P<0.0001). CONCLUSION Hospitals defined as Level II and Level III provided the majority of care and were able to do so with shorter hospitalizations and lower charges, regardless of SOI. As care shifts towards specialized centers, this charge differential may have significant impact on future health care costs. LEVEL OF EVIDENCE Level III Cost Effectiveness Study.
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Affiliation(s)
- Charlotte L Kvasnovsky
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, United States.
| | - Kimberly Lumpkins
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, United States
| | - Jose J Diaz
- Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States
| | - Jeannie Y Chun
- Department of Pediatric Surgery, Providence Children's Health, Portland, OR, United States
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20
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Richards MK, Goldin AB, Ehrlich PF, Beierle EA, Doski JJ, Goldfarb M, Langer M, Nuchtern JG, Vasudevan S, Gow KW. Partial Nephrectomy for Nephroblastoma: A National Cancer Data Base Review. Am Surg 2018. [DOI: 10.1177/000313481808400315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Standard of care for unilateral nephroblastoma includes total nephrectomy (TN) with nodal sampling. We sought to compare the outcomes of TN and partial nephrectomy (PN). We performed a retrospective cohort study of TN and PN for nephroblastoma using the National Cancer Data Base. The outcomes included nodal sampling frequency, margin status, and survival. Categorical and continuous data were evaluated with χ2 and t tests, respectively ( P < 0.05). Generalized linear models evaluated nodal sampling and margin status. Cox regression compared survival. In total, 235 patients underwent PN and 3572 had TN. TN patients were 50 per cent more likely to undergo nodal sampling (RR: 1.47, 95% CI 1.30–1.66). There was no difference in margin status (RR: 0.91, 95% CI 0.65–1.28) or overall survival (HR 1.57; 95% CI 0.78–3.19). This study reports the largest review of patients with PN for unilateral nephroblastoma. PN patients had less nodal sampling but similar margin involvement and overall survival.
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Affiliation(s)
- Morgan K. Richards
- Department of Surgery, University of Washington, Seattle, Washington
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washingon
| | - Adam B. Goldin
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washingon
| | | | | | - John J. Doski
- Methodist Children's Hospital of South Texas, San Antonio, Texas
| | | | | | | | | | - Kenneth W. Gow
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washingon
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Litz CN, Ciesla DJ, Danielson PD, Chandler NM. Effect of hospital type on the treatment of acute appendicitis in teenagers. J Pediatr Surg 2018; 53:446-448. [PMID: 28408075 DOI: 10.1016/j.jpedsurg.2017.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/30/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Teenagers receive appendicitis care at both adult and pediatric facilities. The purpose of this study was to evaluate outcomes following treatment of acute appendicitis in teenagers based on the type of hospital facility. METHODS Patients aged 13-17years with acute appendicitis who were discharged from acute care hospitals from 2009 to 2014 were identified using a statewide discharge dataset. Hospitals were classified as pediatric or adult and outcomes were compared. RESULTS There were 5585 patients treated in adult hospitals and 1625 in pediatric hospitals. Fewer patients at adult hospitals had complicated appendicitis (20.4% vs. 33.0%, p<0.01). Open appendectomy occurred more often in adult hospitals compared to pediatric hospitals (12.6% vs. 6.0%, p<0.01). Pediatric hospitals had higher rates of non-operative management (10% vs. 3.4%, p<0.01) and percutaneous drain placement (1.2% vs. 0.4%, p<0.01). Postoperative complication rates did not significantly differ between hospital types. CONCLUSION Most teenagers undergo appendectomy at adult facilities; however, a greater proportion of younger patients and patients with complicated appendicitis is treated at pediatric hospitals. Treatment at a freestanding children's hospital results in lower rates of open procedures and no difference in complications. Opportunities may exist to standardize care across treating facilities to optimize outcomes and resource use. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Cristen N Litz
- Johns Hopkins All, Children's Hospital, Outpatient Care Center, 601 5(th) Street South, Dept 70-6600, 3(rd) Floor, Saint Petersburg, FL 33701.
| | - David J Ciesla
- University of South Florida, Morsani College of Medicine, 1 Tampa General Circle, G417, Tampa, FL 33606.
| | - Paul D Danielson
- Johns Hopkins All, Children's Hospital, Outpatient Care Center, 601 5(th) Street South, Dept 70-6600, 3(rd) Floor, Saint Petersburg, FL 33701.
| | - Nicole M Chandler
- Johns Hopkins All, Children's Hospital, Outpatient Care Center, 601 5(th) Street South, Dept 70-6600, 3(rd) Floor, Saint Petersburg, FL 33701.
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Malviya S, Voepel-Lewis T. Ensuring Optimal Anesthetic Care for Children: A Call to Action. Anesth Analg 2017. [DOI: 10.1213/ane.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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The American College of Surgeons Children's Surgery Verification and Quality Improvement Program. Curr Opin Anaesthesiol 2017; 30:376-382. [DOI: 10.1097/aco.0000000000000467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016.
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Arca MJ, Goldin AB, Oldham KT. Optimization of care for the pediatric surgical patient: Why now? Semin Pediatr Surg 2015; 24:311-4. [PMID: 26653166 DOI: 10.1053/j.sempedsurg.2015.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 2015, the American College of Surgeons (ACS) has begun to verify hospitals and ambulatory centers which meet consensus based optimal resource standards as "Children׳s Surgical Centers." The intent is to identify children-specific resources available within an institution and using a stratification system similar to the ACS Trauma Program match these to the needs of infants and children with surgical problems. This review briefly summarizes the history, supporting data and processes which drove this initiative.
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Affiliation(s)
- Marjorie J Arca
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI; Children׳s Hospital of Wisconsin, Milwaukee, WI.
| | - Adam B Goldin
- Division of Pediatric Surgery, Seattle Children׳s Hospital, Seattle, WA
| | - Keith T Oldham
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, WI; Children׳s Hospital of Wisconsin, Milwaukee, WI
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Oldham KT, Fallat M, Barnhart D, Derkay C, Deshpande J, Georgeson K, Hirschl R, Houck C, Mooney D, Moss RL, Sawin R, Tuggle D. Reply to a Letter to the Editor. J Pediatr Surg 2015; 50:1434-6. [PMID: 26162971 DOI: 10.1016/j.jpedsurg.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Keith T Oldham
- American College of Surgeons Committee for Children's Surgery.
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