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

• Published in: Journal of pediatric surgery 2014, Vol.49 (1), p.123-128
• Main Authors: McAteer, Jarod P, LaRiviere, Cabrini A, Oldham, Keith T, Goldin, Adam B
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Appendectomy; Appendectomy - statistics & numerical data; Appendicitis - surgery; Child; Child, Preschool; Comorbidity; Designation; Diagnosis-Related Groups; Female; Hospitals, Pediatric - trends; Hospitals, Pediatric - utilization; Humans; Infant; Male; Outcomes; Patient Discharge - statistics & numerical data; Pediatrics; Pediatrics - trends; Postoperative Complications - epidemiology; Pyloric Stenosis - surgery; Pyloromyotomy; Referral and Consultation; Regionalization; Retrospective Studies; Risk; Specialties, Surgical - trends; Specialty; Surgery; Treatment Outcome; Washington - epidemiology
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.09.046

Abstract Background Little data exists on temporal changes in the care of children with common surgical conditions. We hypothesized that an increasing proportion of procedures are performed at pediatric hospitals over time, and that outcomes are superior at these centers. Methods We conducted a retrospective cohort study using Washington State discharge records for children 0–17 years old undergoing appendectomy (n = 39,472) or pyloromyotomy (n = 3,500). Pediatric hospitals were defined as centers with full-time pediatric surgeons. Outcomes were examined for two time periods (1987–2000, 2001–2009). Results From 1987 to 2009, the proportion of procedures performed at pediatric hospitals steadily increased. The percentage for appendectomies increased from 17% to 32%, and that for pyloromyotomies increased from 57% to 99%. For pyloromyotomy, care at a pediatric hospital was associated with decreased risk of postoperative complications (OR = 0.36, p < 0.001) for both time periods. Appendectomy outcomes did not differ significantly in the early time period, but in the later time period specialist care was associated with lower risk of complications in children < 5 years (OR = 0.54, p = 0.03). Conclusion There has been a shift towards pediatric hospitals for certain procedures, with a widening disparity in outcomes for younger children. These results suggest that procedures in younger patients may best be performed by providers familiar with these patient populations.