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Jay G. Berry, MD; Tracy A. Lieu, MD, MPH; Peter W. Forbes, MA; Don A. Goldmann, MD

Arch Pediatr Adolesc Med. 2007;161(1):38-43.

Objectives  To describe hospital volumes for common pediatric specialty operations, to evaluate hospital and patient characteristics associated with operations performed at a low-volume hospital, and to evaluate outcomes with hospital volume.

Design  Retrospective cohort using the Kids' Inpatient Database 2003.

Setting  Discharges from 3438 hospitals in 36 states from 2003.

Participants  Children aged 0 to 18 years undergoing ventriculoseptal defect surgery (n = 2301), tracheotomy (n = 2674), ventriculoperitoneal shunt placement (n = 3378), and posterior spinal fusion (n = 4002).

Main Exposure  Hospital volume.

Main Outcome Measures  In-hospital mortality and postoperative complications.

Results  For tracheotomy and posterior spinal fusion, at least one fourth of the hospitals performed only 1 operation for children aged 0 to 18 years in 2003. For these same operations, at least half of hospitals treated 4 or fewer cases per year. For all operations, discharges from low-volume hospitals were less likely to be from children's or teaching hospitals compared with discharges from higher-volume hospitals. For tracheotomy, children were less likely to experience postoperative complications in high-volume hospitals compared with low-volume hospitals (odds ratio, 0.48; 95% confidence interval, 0.21-1.09).

Conclusions  Many children undergoing common pediatric specialty operations had these procedures performed in low-volume hospitals. Low-volume hospitals were less likely to be children's or teaching hospitals. Children undergoing tracheotomy experienced higher rates of complications in low-volume hospitals. Further research is needed to identify the reasons why so many children have these operations performed in low-volume hospitals.

Author Affiliations: Harvard Pediatric Health Services Research Fellowship Program (Drs Berry, Lieu, and Goldmann), Division of Infectious Diseases (Dr Goldmann), and Clinical Research Program (Mr Forbes), Children's Hospital Boston (Drs Berry, Lieu, and Goldman), Harvard Medical School, and Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care (Dr Lieu), Boston, Mass; and Institute for Healthcare Improvement Cambridge, Mass (Dr Goldmann).

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