Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
Rollins School of Public Health, Emory University, Atlanta, GA.
J Am Coll Surg. 2018 May;226(5):917-924.e1. doi: 10.1016/j.jamcollsurg.2018.02.002. Epub 2018 Feb 17.
The American College of Surgeons in 2015 instituted the Children's Surgery Verification program delineating requirements for hospitals providing pediatric surgical care. Our purpose was to examine possible effects of the Children's Surgery Verification program by evaluating neonates undergoing high-risk operations.
Using the Kid's Inpatient Database 2009, we identified infants undergoing operations for 5 high-risk neonatal conditions. We considered all children's hospitals and children's units Level I centers and considered all others Level II/III. We estimated the number of neonates requiring relocation and the additional distance traveled. We used propensity score adjusted logistic regression to model mortality at Level I vs Level II/III hospitals.
Overall, 7,938 neonates were identified across 21 states at 91 Level I and 459 Level II/III hospitals. Based on our classifications, 2,744 (34.6%) patients would need to relocate to Level I centers. The median additional distance traveled was 6.6 miles. The maximum distance traveled varied by state, from <55 miles (New Jersey and Rhode Island) to >200 miles (Montana, Oregon, Colorado, and California). The adjusted odds of mortality at Level II/III vs Level I centers was 1.67 (95% CI 1.44 to 1.93). We estimate 1 life would be saved for every 32 neonates moved.
Although this conservative estimate demonstrates that more than one-third of complex surgical neonates in 2009 would have needed to relocate under the Children's Surgery Verification program, the additional distance traveled is relatively short for most but not all, and this program might improve mortality. Local level ramifications of this novel national program require additional investigation.
2015 年，美国外科医师学会制定了《儿童外科验证计划》，规定了提供小儿外科护理的医院的要求。我们的目的是通过评估接受高风险手术的新生儿来检查《儿童外科验证计划》的可能效果。
使用 2009 年的儿科住院患者数据库，我们确定了 5 种高危新生儿疾病接受手术的婴儿。我们考虑了所有儿童医院和儿科单位的一级中心，并考虑了所有其他的二级/三级中心。我们估计了需要重新安置的新生儿数量和增加的旅行距离。我们使用倾向评分调整的逻辑回归模型来比较一级和二级/三级医院的死亡率。
在 21 个州的 91 个一级和 459 个二级/三级医院中，共确定了 7938 名新生儿。根据我们的分类，2744 名（34.6%）患者需要转移到一级中心。中位数额外旅行距离为 6.6 英里。最大旅行距离因州而异，从<55 英里（新泽西州和罗得岛州）到>200 英里（蒙大拿州、俄勒冈州、科罗拉多州和加利福尼亚州）。二级/三级与一级中心的死亡率调整比值比为 1.67（95%置信区间 1.44 至 1.93）。我们估计每转移 32 名新生儿可挽救 1 条生命。
尽管这一保守估计表明，2009 年超过三分之一的复杂外科新生儿在《儿童外科验证计划》下需要重新安置，但对于大多数但不是所有的新生儿来说，增加的旅行距离相对较短，该计划可能会提高死亡率。这种新的全国性计划在当地层面的影响需要进一步调查。
