Salazar Jose H, Goldstein Seth D, Yang Jingyan, Gause Colin, Swarup Abhishek, Hsiung Grace E, Rangel Shawn J, Goldin Adam B, Abdullah Fizan
*Department of Surgery, University of Maryland Medical Center, Baltimore, MD†Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD‡Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY§Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL¶Kasturba Medical College, Manipal, Karnataka, India||Department of Surgery, Children's Hospital Boston, Boston, MA#Department of Surgery, Seattle Children's Hospital, Seattle, WA**Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Ann Surg. 2016 Jun;263(6):1062-6. doi: 10.1097/SLA.0000000000001666.
This study aims to characterize the delivery of pediatric surgical care based on hospital volume stratified by disease severity, geography, and specialty. Longitudinal regionalization over the 10-year study period is noted and further explored.
The Kids' Inpatient Database (KID) was queried from 2000 to 2009 for patients <18 years undergoing noncardiac surgery. Hospitals nationwide were grouped into commutable regions and identified as high-volume centers (HVCs) if they had more than 1000 weighted procedures per year. Regions that had at least one HVC and one or more additional lower volume center were included for analysis. Low-risk, high-risk neonatal, and surgical subspecialties were analyzed separately.
A total of 385,242 weighted pediatric surgical admissions in 33 geographical regions and 224 hospitals were analyzed. Overall, HVCs comprised 33 (14.7%) hospitals, medium-volume center (MVC) 33 (14.7%), and low-volume center (LVC) 158 (70.5%). The four low-risk procedures analyzed were increasingly regionalized: appendectomy (52% in HVCs in 2000 to 60% in 2009, P < 0.001), fracture reduction (63% to 68%, P < 0.001), cholecystectomy (54% to 63%, P < 0.001), and pyloromyotomy (65% to 85%, P < 0.001). Neonatal surgery showed significant regionalization trends for tracheoesophageal fistula (66% to 87%, P < 0.001) and gastroschisis (76% to 89%, P < 0.001).
This is the first large-scale, multi-region analysis to demonstrate that pediatric surgical care has transitioned to HVCs over a recent decade, particularly for low-risk patients. It is important for practitioners and policymakers alike to understand such volume trends in order to ensure hospital capacity while maintaining an optimal quality of care.
本研究旨在根据疾病严重程度、地理位置和专科对医院规模进行分层，以描述小儿外科护理的提供情况。记录并进一步探讨了10年研究期间的纵向区域化情况。
查询2000年至2009年儿童住院数据库（KID）中18岁以下接受非心脏手术的患者。全国的医院被分组为可通勤区域，如果每年有超过1000例加权手术，则被确定为高容量中心（HVC）。至少有一个HVC和一个或多个其他低容量中心的区域被纳入分析。低风险、高风险新生儿和外科亚专科分别进行分析。
共分析了33个地理区域和224家医院的385,242例加权小儿外科入院病例。总体而言，HVC包括33家（14.7%）医院，中等容量中心（MVC）33家（14.7%），低容量中心（LVC）158家（70.5%）。分析的四种低风险手术的区域化程度越来越高：阑尾切除术（2000年HVC中为52%，2009年为60%，P<0.001）、骨折复位术（63%至68%，P<0.001）、胆囊切除术（54%至63%，P<0.001）和幽门肌切开术（65%至85%，P<0.001）。新生儿手术在气管食管瘘（66%至87%，P<0.001）和腹裂（76%至89%，P<0.001）方面显示出显著的区域化趋势。
这是首次大规模、多区域分析，表明小儿外科护理在最近十年已转向HVC，特别是对于低风险患者。从业者和政策制定者了解此类规模趋势非常重要，以便在保持最佳护理质量的同时确保医院容量。
