Hospital Variation in Mortality and Failure to Rescue after Surgery for High-Risk Neonatal Diagnoses.

Autor:	Mehl SC; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA., Portuondo JI; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA., Tian Y; Surgical Outcomes and Quality Improvement Center, Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Raval MV; Surgical Outcomes and Quality Improvement Center, Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., King A; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA., Rialon KL; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA., Vogel AM; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA., Wesson DE; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.; Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA., Shah SR; Pediatrix Surgery of Houston, Houston, Texas, USA., Massarweh NN; Surgical and Perioperative Care, Atlanta VA Health Care System, Decatur, Georgia, USA.; Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Neonatology [Neonatology] 2024; Vol. 121 (1), pp. 34-45. Date of Electronic Publication: 2023 Oct 16.
DOI:	10.1159/000533825
Abstrakt:	Introduction: A large proportion of postoperative mortality after pediatric surgery occurs among neonates with specific high-risk diagnoses. The extent to which there is hospital-level mortality variation among patients with these diagnoses and whether this variation is associated with differences in failure to rescue (FTR) is unclear. Methods: The Pediatric Health Information System® database (2012-2020) was used to identify patients who underwent surgery for eight high-risk neonatal diagnoses: gastroschisis; volvulus; necrotizing enterocolitis; intestinal atresia; meconium peritonitis; tracheoesophageal fistula; congenital diaphragmatic hernia; and perinatal intestinal perforation. Hospitals were stratified into tertiles of reliability-adjusted inpatient mortality rates (lower than average mortality - tertile 1 [T1]; higher than average mortality - tertile 3 [T3]). Multivariable hierarchical regression was used to evaluate the association between hospital-level, reliability-adjusted mortality and FTR. Results: Overall, 20,838 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 4.0% (95% CI, 0.0-8.2) to 16.3% (12.2-20.4). Median case volume (range, 80-1,238) and number of NICU beds (range, 24-126) were not significantly different across hospital tertiles. Compared to the hospitals with the lowest postoperative mortality (T1), the odds of FTR were significantly higher in hospitals with the highest (T3) postoperative mortality (odds ratio 1.97 [1.50-2.59]). Conclusions: Significant variation in neonatal hospital mortality for high-risk diagnoses does not appear to be explained by hospital structural characteristics. Rather, difference in FTR suggests quality improvement interventions targeting early recognition and management of postoperative complications could improve surgical quality and safety for high-risk neonatal care. (© 2023 S. Karger AG, Basel.)
Databáze:	MEDLINE
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