A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes

Safford, Shawn D.; Pietrobon, Ricardo; Safford, Kristine M.; Martins, Henrique; Skinner, Michael A.; Rice, Henry E.

doi:10.1016/j.jpedsurg.2005.03.011

Cited by 87 publications

(66 citation statements)

References 19 publications

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“…Traditionally, research has shown an association between low case volume and poor outcomes in a multitude of surgical procedures, [1][2][3][4][5] such as hysterectomy, 6 pancreatectomy, 5,7 esophagectomy, 5 pelvic exenteration, 5 and coronary artery bypass surgery. 2,8,9 Studies have also shown this relationship in several pediatric procedures of varying complexity, such as cardiac surgery, 10,11 pyloromyotomy, 12 appendectomy, 13,14 and inguinal hernia repairs. 13,14 In the field of transplantation, a landmark manuscript published in 1999 suggested that programs performing ,20 transplants per year had inferior outcomes.…”

Section: What This Study Addsmentioning

confidence: 91%

Pediatric Liver Transplant Center Volume and the Likelihood of Transplantation

et al. 2015

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Section: What This Study Addsmentioning

confidence: 91%

Pediatric Liver Transplant Center Volume and the Likelihood of Transplantation

et al. 2015

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“…Pediatrics 2012;129:e370-e376 Several previous studies have documented a relationship between center volume and outcome in children undergoing a variety of surgical procedures including liver transplant, appendectomy, pyloromyotomy, and heart surgery. [1][2][3][4][5][6][7][8][9][10] In children undergoing heart surgery, it has been shown that higher surgical volume is associated with improved survival, particularly for high risk surgeries. 1 However, there are limited data regarding factors that may mediate this volume-outcome relationship, and may thus be targeted for quality improvement.…”

Section: Methodsmentioning

confidence: 99%

Association of Center Volume With Mortality and Complications in Pediatric Heart Surgery

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume-outcome relationship. WHAT THIS STUDY ADDS:A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. abstract OBJECTIVE: Previous analyses have suggested center volume is associated with outcome in children undergoing heart surgery. However, data are limited regarding potential mediating factors, including the relationship of center volume with postoperative complications and mortality in those who suffer a complication. We examined this association in a large multicenter cohort.METHODS: Children 0 to 18 years undergoing heart surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006Database ( -2009 were included. In multivariable analysis, we evaluated outcomes associated with annual center volume, adjusting for patient factors and surgical risk category.RESULTS: A total of 35 776 patients (68 centers) were included. Overall, 40.6% of patients had $1 complication, and the in-hospital mortality rate was 3.9%. The mortality rate in those patients with a complication was 9.0%. In multivariable analysis, lower center volume was significantly associated with higher in-hospital mortality. There was no association of center volume with the rate of postoperative complications, but lower center volume was significantly associated with higher mortality in those with a complication (P = .03 when volume examined as a continuous variable; odds ratio in centers with ,150 vs .350 cases per year = 1.59 [95% confidence interval: 1.16-2.18]). This association was most prominent in the higher surgical risk categories.CONCLUSIONS: These data suggest that the higher mortality observed at lower volume centers in children undergoing heart surgery may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. Pediatrics 2012;129:e370-e376 AUTHORS:

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“…Drawing from the experience of bile duct injuries in the early days of laparoscopic cholecystectomy, it is recognized that the surgeon learning curve may adversely affect outcomes. Surgeon specialty (pediatric surgeon vs general surgeon; [12,47]) and surgical volume [48] impacts quality of pyloromyotomy reflected in higher mucosal perforation rates or inadequate muscle split even in the open surgical experience. Similarly, there is evidence that laparoscopic pyloromyotomy has a higher rate of complications when performed by less-experienced trainees.…”

Section: Simulators In Pediatric Surgerymentioning

confidence: 99%