Shifts towards pediatric specialists in the treatment of appendicitis and pyloric stenosis: Trends and outcomes

McAteer, Jarod P.; LaRiviere, Cabrini A.; Oldham, Keith T.; Goldin, Adam B.

doi:10.1016/j.jpedsurg.2013.09.046

Cited by 47 publications

(30 citation statements)

References 23 publications

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“…Our current study provides further evidence that regionalization of pediatric cardiac surgeries has also progressed. This regionalization was mainly attributable to trends among low‐ and medium‐risk patients, echoing results from previous studies in other areas of surgical care …”

Section: Discussionsupporting

confidence: 82%

Impact of pediatric cardiac surgery regionalization on health care utilization and mortality

Sakai‐Bizmark

Mena

Kumamaru

et al. 2019

Health Services Research

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Objective Regionalization directs patients to high‐volume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery. Data Sources/Study Setting Statewide inpatient data from eleven states between 2000 and 2012. Study Design Mortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital case‐volume, categorized into low‐, medium‐, and high‐volume tertiles. Data Collection/Extraction Methods We used Risk Adjustment for Congenital Heart Surgery‐1 (RACHS‐1) to select pediatric cardiac surgery discharges. Principal Findings In total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low‐, medium‐, and high‐volume hospitals. Mortality decreased over time, but remained higher in low‐ and medium‐volume hospitals. High‐volume hospitals had lower odds of mortality and cost than low‐volume hospitals (odds ratio [OR] 0.59, P < 0.01, and relative risk [RR] 0.91, P < 0.01, respectively). LOS was longer for high‐ and medium‐volume hospitals, compared to low‐volume hospitals (high‐volume: RR 1.18, P < 0.01; medium‐volume: RR 1.05, P < 0.01). Conclusions Regionalization reduced mortality and cost, indicating fewer complications, but paradoxically increased LOS. Further research is needed to explore the full impact on health care utilization.

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Section: Discussionsupporting

confidence: 82%

Impact of pediatric cardiac surgery regionalization on health care utilization and mortality

Sakai‐Bizmark

Mena

Kumamaru

et al. 2019

Health Services Research

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“…These results mirror prior work from the KID database by Smink et al [32] demonstrating that almost two thirds of pediatric appendectomies are performed at hospitals performing less than one appendectomy per week. Trends indicate that regionalization of common pediatric surgical procedures, such as appendectomy, is already happening [33]. There are several limitations to this study starting with the retrospective analysis of administrative data.…”

Section: Discussionmentioning

confidence: 99%

Assessment of variation in care and outcomes for pediatric appendicitis at children's and non-children's hospitals

Tian

Heiss

Wulkan

et al. 2015

Journal of Pediatric Surgery

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“…Although the overall complication rate did not change between time periods, undergoing surgery in a pediatric centre was clearly protective for postoperative complications. McAteer and colleagues 6 found a similar trend in the state of Washington for preferential referral to pediatric centres for appendicitis and HPS between 1987 and 2009. In their study, referral to pediatric centres in Washington was associated with decreased postoperative complications.…”

Section: Management Of Hps In the Maritimes Between 2001 Andmentioning

confidence: 83%

“…These findings were corroborated in studies in Washington and Ontario. 6,7 The topic of pediatric surgical regionalization is not a novel concept, and there is substantial evidence to suggest that the majority of pediatric surgery should be performed at pediatric centres to decrease overall morbidity, mortality and LOS. Increased pediatric centre referral is a trend in multiple areas of North America.…”

Section: Management Of Hps In the Maritimes Between 2001 Andmentioning

confidence: 99%

Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time

Ednie

Amram

Creaser

et al. 2016

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Background: Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care. Methods:We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management. Results:We assessed 751 cases of HPS. During the study period (Jan. 1, 2001-Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS.

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Shifts towards pediatric specialists in the treatment of appendicitis and pyloric stenosis: Trends and outcomes

Cited by 47 publications

References 23 publications

Impact of pediatric cardiac surgery regionalization on health care utilization and mortality

Impact of pediatric cardiac surgery regionalization on health care utilization and mortality

Assessment of variation in care and outcomes for pediatric appendicitis at children's and non-children's hospitals

Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time

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