C. Tom1, C. Niino2, A. D. Lee2, E. Saab2, S. Friedlander3, S. L. Lee1,2,3 1Harbor-University Of California Los Angeles Medical Center,Department Of Surgery,Torrance, CA, USA 2University Of California Los Angeles,Department Of Surgery,Los Angeles, CA, USA 3Los Angeles Biomedical Research Institute,Torrance, CA, USA
Introduction: For many surgical operations, there is a well-established relationship between surgical volume and outcome. In the field of pediatric surgery, this has been shown to be true for conditions requiring complex operations, however, for common conditions this relationship is less clear. This study investigated the relationship between hospital volume and surgical outcomes for infants affected by hypertrophic pyloric stenosis.
Methods: Kid’s Inpatient Database (KID) was used to identify patients with congenital hypertrophic pyloric stenosis who underwent pyloromyotomy for years 2003, 2006, 2009, and 2012. Surgical outcomes were measured by length of stay (LOS), complication rates, mortality, and cost. Hospitals were stratified based on case volume. Low-volume hospitals had the lowest quartile of patients treated per year, medium-volume hospitals had the middle two quartiles, and high-volume hospitals had the highest quartile of patients.
Results: A total of 2,234 hospitals treated 51,792 patients with pyloric stenosis. The majority of hospitals were low-volume (n=1,834), while only 51 were high-volume. The overall mortality rate was 0.1% and the median length of stay was 2 days. Females were associated with higher complication rates. Results of multivariate analysis are summarized in table. High-volume hospitals were associated with lower complication rate and increased cost compared to medium- or low-volume hospitals. There were no differences in mortality or LOS.
Conclusion: Using national data, we found that patients with hypertrophic pyloric stenosis treated at high-volume hospitals have improved outcomes despite higher costs. This indicates a benefit to receiving treatment for pyloric stenosis at a high-volume hospital.
