A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes

• Published in: Journal of pediatric surgery 2005-06, Vol.40 (6), p.967-973
• Main Authors: Safford, Shawn D., Pietrobon, Ricardo, Safford, Kristine M., Martins, Henrique, Skinner, Michael A., Rice, Henry E.
• Format: Article
• Language: English
• Subjects: Clinical Competence - economics; Clinical Competence - statistics & numerical data; Databases as Topic; Digestive System Surgical Procedures - economics; Digestive System Surgical Procedures - mortality; Digestive System Surgical Procedures - utilization; Female; Gastric Mucosa - injuries; Hospital Costs - statistics & numerical data; Humans; Infant; Infant, Newborn; Intestinal Mucosa - injuries; Intestinal Perforation - epidemiology; Intraoperative Complications; Length of Stay - statistics & numerical data; Logistic Models; Male; Outcome Assessment (Health Care); Postoperative Complications - epidemiology; Pyloric Stenosis, Hypertrophic - epidemiology; Pyloric Stenosis, Hypertrophic - surgery; Retrospective Studies
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2005.03.011

The availability of large clinical databases allows for careful evaluation of surgical practices, indicators of quality improvement, and cost. We used a large clinical database to compare the effect of surgeon and hospital volume for the care of children with hypertrophic pyloric stenosis (HPS). Patients with International Classification of Diseases-9 codes for HPS and pyloromyotomy were selected from the 1994 to 2000 National Inpatient Samples database. Multiple and logistic regression models were used to evaluate the risk-adjusted association between provider volume and outcomes. Postoperative complications occurred in 2.71% of patients. Patients operated on by low- and intermediate-volume surgeons were more likely to have complications compared with those operated on by high-volume surgeons (95% confidence interval [CI], 1.25-3.78 and 95% CI, 1.25-2.69, respectively). Patients operated at low-volume hospitals were 1.6 times more likely to have complications compared with those operated at intermediate- or high-volume hospitals (95% CI, 1.19-2.20). Procedures performed at high-volume hospitals were less expensive than those at intermediate-volume hospitals by a margin of $910 (95% CI, $443-$1377). These data represent the largest study to date on the epidemiology, complication rate, and cost for care for HPS. Patients treated by both high-volume surgeons and at high-volume hospitals have improved outcomes at less cost.