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Peiffer SE, Hosek K, Gyimah M, Powell P, Mehl SC, Keswani SG, King A. Characteristics and Outcomes of Infants in Texas by Facility Children's Surgery Verification Status. J Surg Res 2024; 302:784-789. [PMID: 39222557 DOI: 10.1016/j.jss.2024.07.115] [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: 12/01/2023] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The American College of Surgeons Children's Surgery Verification (CSV) status recognizes hospitals that deliver high-quality pediatric surgical care. Texas has 5 CSV centers in three cities, which may limit equitable access to care. We explored the characteristics and outcomes of infants admitted in Texas as a function of facility CSV status. MATERIALS AND METHODS We retrospectively reviewed a state-wide hospital discharge database (2013-2021). All patients <1 y of age were included. Patients transferred to an outside hospital were excluded to avoid double counting. Descriptive statistics and chi-square analysis were performed. RESULTS We analyzed 3,617,173 admissions, with 211,278 (6%) treated at CSV centers. CSV admissions were less likely to be inborn (46% versus 93%) and more likely to be transfers (16% versus 1%). CSV centers also had sicker patients (32% versus 13% extreme illness severity) with higher mortality rates (1% versus 0%), longer length of stay (9 ± 22 versus 4 ± 9), and higher operative rates (33% versus 20%). However, mortality was lower at CSV centers when matched for illness severity. Proportionately more patients from rural counties (9% versus 4%) and counties along the United States-Mexico border (13% versus 1%), as well as patients of Hispanic ethnicity (39% versus 33%), were treated at non-CSV centers. Meanwhile, proportionately more African Americans (21% versus 11%) were treated at CSV centers. CONCLUSIONS CSV centers are associated with improved outcomes among patients with high illness severity. Population differences among patients treated at CSV centers compared to non-CSV centers may represent disparities in access to care and warrant further evaluation.
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Affiliation(s)
- Sarah E Peiffer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Kathleen Hosek
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Michael Gyimah
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Paulina Powell
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Steven C Mehl
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Sundeep G Keswani
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Alice King
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.
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Sun M, Chen WM, Wu SY, Zhang J. Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis. Eur J Pediatr 2024; 183:619-628. [PMID: 37943333 DOI: 10.1007/s00431-023-05308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
This study aimed to examine the association between hospital volume and postoperative outcomes in pediatric major surgery using a nationwide database. The study included pediatric patients who underwent first major elective inpatient surgery and hospitalization for more than 1 day. The results showed no significant difference in the risk of 30-day postoperative mortality based on hospital volume. However, patients in the middle- and high-volume groups had significantly lower rates of 30-day major complications, particularly deep wound infection. In terms of 90-day postoperative outcomes, patients in the high-volume group had a significantly lower risk of mortality and lower rates of major complications, particularly deep wound infection, pneumonia, and septicemia. Conclusions: The study suggests that pediatric patients undergoing major surgery in high and middle-volume groups have better outcomes in terms of major complications compared to the low-volume group. What is Known: • Limited evidence exists on the connection between hospital volume and pediatric surgery outcomes. What is New: • A Taiwan-based study, using national data, found that high and middle hospital-volume groups experienced significantly lower rates of major complications within 30 and 90 days after surgery. • High-volume hospitals demonstrated a substantial decrease in the risk of 90-day postoperative mortality. • The study underscores the importance of specialized pediatric surgical centers and advocates for clear guidelines for hospital selection, potentially improving outcomes and informing future health policies.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St.Yilan County 265, Luodong Township, Taiwan.
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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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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Yau A, Lentskevich MA, Yau I, Reddy NK, Ahmed KS, Gosain AK. Do Unpaid Children's Hospital Account Balances Correlate with Family Income or Insurance Type? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5310. [PMID: 37799440 PMCID: PMC10550046 DOI: 10.1097/gox.0000000000005310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
Background Current understanding of medical debt among various income ranges and insurance carriers is limited. We analyzed median household incomes, insurance carriers, and medical debt of plastic surgery patients at a major metropolitan children's hospital. Methods A retrospective chart review for zip codes, insurance carriers, and account balances was conducted for 2018-2021. All patients were seen by members of the Division of Pediatric Plastic Surgery at Ann and Robert H. Lurie Children's Hospital of Chicago. Blue Cross was reported separately among other commercial insurance carriers by the hospital's business analytics department. Median household income by zip code was obtained. IBM SPSS Statistics was used to perform chi-squared tests to study the distribution of unpaid account balances by income ranges and insurance carriers. Results Of the 6877 patients, 630 had unpaid account balances. Significant differences in unpaid account balances existed among twelve insurance classes (P < 0.001). There were significant differences among unpaid account balances when further examined by median household income ranges for Blue Cross (P < 0.001) and other commercial insurance carriers (P < 0.001). Conclusions Although patients with insurance policies requiring higher out-of-pocket costs (ie, Blue Cross and other commercial insurance carriers) are generally characterized by higher household incomes, these patients were found to have higher unpaid account balances than patients with public insurance policies. This suggests that income alone is not predictive of unpaid medical debt and provides greater appreciation of lower income families who may make a more consistent effort in repaying their medical debt.
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Affiliation(s)
- Alice Yau
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Marina A. Lentskevich
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Irene Yau
- William Beaumont Army Medical Center, El Paso, Tex
| | - Narainsai K. Reddy
- Texas A&M Health Science Center, Engineering Medicine (EnMed), Bryan, Tex
| | - Kaleem S. Ahmed
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
| | - Arun K. Gosain
- From the Division of Plastic Surgery, Ann and Robert H. Lurie Children’s Hospital, Northwestern University School of Medicine, Chicago, Ill
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Keane OA, Lally KP, Kelley-Quon LI. Rise of pediatric surgery collaboratives to facilitate quality improvement. Semin Pediatr Surg 2023; 32:151278. [PMID: 37156645 DOI: 10.1016/j.sempedsurg.2023.151278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Broad changes in pediatric surgical care delivery are limited by the rarity of pediatric surgical diseases and the geographic dispersion of pediatric surgical care across different hospital types. Pediatric surgical collaboratives and consortiums can provide the patient sample size, research resources, and infrastructure to advance clinical care for children with who require surgery. Additionally, collaboratives can bring together experts and exemplar institutions to overcome barriers to pediatric surgical research to advance quality surgical care. Despite challenges to collaboration, many successful pediatric surgical collaboratives emerged in the last decade and continue to push the field forward towards high-quality, evidence-based care and improved outcomes. This review will discuss the need for continued research and quality improvement collaboratives in pediatric surgery, identify challenges faced when building collaboratives, and introduce future directions to expand impact.
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Affiliation(s)
- Olivia A Keane
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Department of Surgery, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at UT Health Houston and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Department of Surgery, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Berry JG, Rodean J, Leahy I, Rangel S, Johnson C, Crofton C, Staffa SJ, Hall M, Methot C, Desmarais A, Ferrari L. Hospital Volumes of Inpatient Pediatric Surgery in the United States. Anesth Analg 2021; 133:1280-1287. [PMID: 34673726 DOI: 10.1213/ane.0000000000005748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Perioperative outcomes of children depend on the skill and expertise in managing pediatric patients, as well as integration of surgical, anesthesiology, and medical teams. We compared the types of pediatric patients and inpatient surgical procedures performed in low- versus higher-volume hospitals throughout the United States. METHODS Retrospective analysis of 323,258 hospitalizations with an operation for children age 0 to 17 years in 2857 hospitals included in the Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database (KID) 2016. Hospitals were categorized by their volume of annual inpatient surgical procedures. Specific surgeries were distinguished with the AHRQ Clinical Classification System. We assessed complex chronic conditions (CCCs) using Feudtner and Colleagues' system. RESULTS The median annual volume of pediatric inpatient surgeries across US hospitals was 8 (interquartile range [IQR], 3-29). The median volume of inpatient surgeries for children with a CCC was 4 (IQR, 1-13). Low-volume hospitals performed significantly fewer types of surgeries (median 2 vs 131 types of surgeries in hospitals with 1-24 vs ≥2000 volumes). Appendectomy and fixation of bone fracture were among the most common surgeries in low-volume hospitals. As the volume of surgical procedures increased from 1 to 24 to ≥2000, the percentage of older children ages 11 to 17 years decreased (70.9%-32.0% [P < .001]) and the percentage of children with a CCC increased (11.2%-60.0% [P < .001]). CONCLUSIONS Thousands of US hospitals performed inpatient surgeries on few pediatric patients, including those with CCCs who have the highest risk of perioperative morbidity and mortality. Evaluation of perioperative decision making, workflows, and pediatric clinicians in low- and higher-volume hospitals is warranted.
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Affiliation(s)
- Jay G Berry
- From the Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Rodean
- Department of Informatics and Statistics, Children's Hospital Association, Overland Park, Kansas
| | - Izabela Leahy
- Department of Anesthesiology, Perioperative, and Pain Medicine
| | - Shawn Rangel
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Connor Johnson
- Department of Anesthesiology, Perioperative, and Pain Medicine
| | - Charis Crofton
- From the Complex Care Service, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Perioperative, and Pain Medicine
| | - Matt Hall
- Department of Informatics and Statistics, Children's Hospital Association, Overland Park, Kansas
| | - Craig Methot
- Department of Anesthesiology, Perioperative, and Pain Medicine
| | - Anna Desmarais
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Lynne Ferrari
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Department of Anesthesiology, Perioperative, and Pain Medicine
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Gasmi O, Hodel K, Launay E, Paillé C, Chabrol B, Delacourt C, Guen CGL. Pediatric hospital care organization: Cross-sectional enquiry in four regions in France. Arch Pediatr 2021; 28:509-513. [PMID: 34511279 DOI: 10.1016/j.arcped.2021.08.007] [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: 04/01/2021] [Revised: 06/10/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to characterize conventional pediatric care capacities in French public hospitals and identify the main difficulties in guiding upcoming health policies. The secondary objective was to assess the quality of care by the implementation of the European Charter of the Rights of Children in Hospital. METHOD Multicenter cross-sectional study using a questionnaire survey sent by e-mail to the heads of conventional pediatric departments in four French regions identified on the French Hospital Federation's website. The survey was conducted between 25 September and 25 October 2018. RESULTS Fifty-six of 113 heads of departments participated in the survey. The mean annual number of admissions per unit in 2017 was 2066 (SD, 1433), with a median length of stay of 2.7 days (range, 1-10). Children were admitted up to age 18 years in 76% of the departments, and 83% of the departments had an individualized pediatric emergency department. The nurse care load was very high, specifically during the night shift (9.5 patients/nurse). Inpatient education and academic teaching were unavailable in 38% of the departments. Overall, 89% of department heads declared knowing the European Charter of the Rights of Children in Hospital, and a copy of it was posted in all units in 57% (95% confidence interval, 44-70) of the services/departments. At all times and in all departments, parents were allowed to be with their children, and for 34% (95% CI, 21-47) of the departments, an accommodation for parents was available close to the hospital. CONCLUSION Public hospital pediatric departments lack sufficient medical and nonmedical caregivers. Department heads were well aware of the European Charter, and it was well disseminated but should be updated to address today's challenges in pediatrics. An area of improvement would be to include parents in their child's care more effectively.
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Affiliation(s)
- O Gasmi
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France.
| | - K Hodel
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, 85 rue Saint-Jacques, 44093 Nantes, France
| | - E Launay
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France
| | - C Paillé
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, 85 rue Saint-Jacques, 44093 Nantes, France
| | - B Chabrol
- Department of General Pediatrics, University Hospital of la Timone, APHM, 264 rue Saint-Pierre, 13005 Marseille, France
| | - C Delacourt
- Department of Pediatric Pneumology, Necker-Enfants Malades University Hospital, APHP, 149 rue de Sèvres, 75743 Paris, France
| | - C Gras-Le Guen
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France
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