Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals

被引:5
作者
Tom, Cynthia M. [1 ]
Won, Roy P. [1 ]
Lee, Alexander D. [1 ]
Friedlander, Scott [2 ,3 ]
Sakai-Bizmark, Rie [2 ,3 ]
Lee, Steven L. [1 ,2 ,3 ]
机构
[1] Harbor UCLA Med Ctr, Dept Surg, Torrance, CA 90509 USA
[2] Harbor UCLA Med Ctr, Dept Pediat, Torrance, CA 90509 USA
[3] Los Angeles Biomed Res Inst, Torrance, CA USA
关键词
Pediatric appendicitis; Pediatric cholecystectomy; Outcomes; Costs; Children's hospital; Nonchildren's hospital; OPEN APPENDECTOMY; LAPAROSCOPIC CHOLECYSTECTOMY; NEGATIVE APPENDECTOMY; INSURANCE STATUS; APPENDICITIS; MANAGEMENT; CHILDHOOD; VOLUME; IMPACT; CARE;
D O I
10.1016/j.jss.2018.06.021
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Variations in the management of pediatric patients at children's hospitals (CHs) and non-CHs (NCHs) have been well described, especially within the trauma literature. However, little is known about the outcomes and costs of common general surgical procedures at NCHs. The purpose of this study was to evaluate the effect of CH designation on the outcomes and costs of appendectomy and cholecystectomy. Methods: The Kids' Inpatient Database (2003-2012) was queried for patients aged under 18 y who underwent appendectomy or cholecystectomy at CHs and NCHs. Outcomes analyzed included disease severity, complications, laparoscopy, length of stay (LOS), and cost. Results: Most of appendectomies and cholecystectomies were performed at NCHs. Overall, CHs cared for younger children were more likely to be teaching hospitals, had higher costs, and longer LOS. On multivariate analysis for appendectomies, CHs were associated with higher rates of perforated appendicitis (OR = 1.53, 95% CI = 1.42-1.66, P < 0.001), less complications (OR = 0.68, 95% CI = 0.61-0.75, P < 0.001), increased laparoscopy (OR = 2.93, 95% CI = 2.36-3.64, P < 0.001), longer LOS (RR = 1.13, 95% CI = 1.09-1.17, P < 0.001), and higher costs (exponentiated log $ = 1.19, 95% CI = 1.13-1.24, P < 0.001). Multivariate analysis for cholecystectomies revealed that CHs were associated with less laparoscopy (OR = 0.58, 95% CI = 0.50-0.67, P < 0.001), longer LOS (RR = 1.26, 95% CI = 1.19-1.34, P < 0.001), and higher costs (exponentiated log $ = 1.29, 95% CI = 1.22-1.37, P < 0.001) with similar complications. Independent predictors of LOS and cost included CH designation, negative appendectomy, perforated appendicitis, complications, younger age, black patients, and public insurance. Conclusions: Variations in surgical management, outcomes, and costs after appendectomy and cholecystectomy exist between CHs and NCHs. CHs excelled in treating complicated appendicitis. NCHs effectively performed cholecystectomies. These differences in outcomes require further investigation to identify modifiable factors to optimize care across all hospitals for these common surgical diseases. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:63 / 71
页数:9
相关论文
共 33 条
[1]  
[Anonymous], 2018, CPI Inflation Calculator
[2]  
[Anonymous], 2014, J AM COLL SURG
[3]   Laparoscopic versus open appendectomy in children - A meta-analysis [J].
Aziz, O ;
Athanasiou, T ;
Tekkis, PP ;
Purkayastha, S ;
Haddow, J ;
Malinovski, V ;
Paraskeva, P ;
Darzi, A .
ANNALS OF SURGERY, 2006, 243 (01) :17-27
[4]   Association of Health Care Utilization With Rates of Perforated Appendicitis in Children 18 Years or Younger [J].
Baxter, Katherine J. ;
Nguyen, Hannah T. M. H. ;
Wulkan, Mark L. ;
Raval, Mehul V. .
JAMA SURGERY, 2018, 153 (06) :544-550
[5]   Hospital characteristics associated with the management of pediatric splenic injuries [J].
Bowman, SM ;
Zimmerman, FJ ;
Christakis, DA ;
Sharar, SR ;
Martin, DP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (20) :2611-2617
[6]   Surgeon volume trumps specialty: outcomes from 3596 pediatric cholecystectomies [J].
Chen, Kesi ;
Cheung, Kevin ;
Sosa, Julie A. .
JOURNAL OF PEDIATRIC SURGERY, 2012, 47 (04) :673-680
[7]   The impact of surgeon choice on the cost of performing laparoscopic appendectomy [J].
Chu, Thomas ;
Chandhoke, Ryan A. ;
Smith, Paul C. ;
Schwaitzberg, Steven D. .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2011, 25 (04) :1187-1191
[8]   Comparison of childhood appendicitis management in the regional paediatric surgery unit and the district general hospital [J].
Collins, Hannah L. ;
Almond, Sarah L. ;
Thompson, Ben ;
Lacy, David ;
Greaney, Martin ;
Baillie, Colin T. ;
Kenny, Simon E. .
JOURNAL OF PEDIATRIC SURGERY, 2010, 45 (02) :300-302
[9]  
Gahagan JV, 2016, AM SURGEON, V82, P921
[10]   Evaluation of race and insurance status as predictors of undergoing laparoscopic appendectomy in children [J].
Hagendorf, Benjamin A. ;
Liao, Jason G. ;
Price, Mitchell R. ;
Burd, Randall S. .
ANNALS OF SURGERY, 2007, 245 (01) :118-125