Research: Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.

Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.

Pruitt LCC1Skarda DE2Barnhart DC2Bucher BT2.

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The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. We elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.


We used data from 49 US children’s hospitals between 2007 and 2017 for the following procedures: congenital diaphragmatic hernia repair (CDH), esophageal atresia and tracheoesophageal fistula repair (EA/TEF), and pull-through for Hirschsprung disease (HD). Mixed effects logistic regression modeling was used to adjust for salient patient characteristics to determine the effect of HHI on in-hospital mortality, condition-specific one-year re-operation, and one-year unplanned readmissions.


A total of 2270 infants were identified who underwent surgery for the three conditions of interest. On multivariable analysis, increasing HHI was not associated with differences in mortality or condition-specific re-operation within the first year. A decrease in the number of unplanned readmissions at highly concentrated centers was seen for HD (RR 0.8 CI (0.69-0.97), p = 0.02) and CDH (RR 0.4 CI (0.28-0.71), p < 0.001).


Pediatric surgical specialization did not affect mortality or condition-specific re-operation. However, it did decrease the number of unplanned readmissions following CDH repairs and pull-throughs for HD.


Retrospective Cohort Study.


Level II.

Copyright © 2020 Elsevier Inc. All rights reserved.


Health services research; Neonatal; Pediatric surgery; SpecializationPMID: 32173118 DOI: 10.1016/j.jpedsurg.2020.02.044

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