Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy
| Autor: | Shawn J. Rangel, Morgan K. Richards, Fizan Abdullah, Adam B. Goldin, Keith T. Oldham, Andy Stergachis, Jarod P. McAteer |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Hospitals Rural medicine.medical_treatment Specialty Pyloromyotomy Pyloric Stenosis Odds Hospitals Urban Postoperative Complications Pediatric surgery medicine Appendectomy Humans Postoperative Period Child Pylorus Retrospective Studies business.industry Incidence Confounding Infant Newborn Infant Postoperative complication Retrospective cohort study General Medicine Appendicitis Hospitals Pediatric United States Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Female Surgery Residence business Follow-Up Studies |
| Zdroj: | Journal of Pediatric Surgery. 50:1549-1555 |
| ISSN: | 0022-3468 |
| Popis: | The effects of hospital location and designation on postoperative pediatric outcomes remain unclear. We hypothesized that urban hospital outcomes would be superior to rural hospitals, and that outcomes at urban centers would differ for children from rural versus urban counties.Retrospective cohort study of children undergoing appendectomy (n=129,507) and pyloromyotomy (n=13,452) using the 2006/2009 KID databases. Hospitals were characterized by specialty designation and classified as urban/rural. County of residence was classified as urban/rural. Outcomes included complications and length of stay. Multivariate regression models were used to adjust for confounding.Among appendectomy patients, treatment at urban hospitals was associated with reduced odds of any postoperative complication (OR=0.77, 95% C.I. 0.70-0.85) and anesthesia-related complications (OR=0.72, 95% C.I. 0.57-0.91). This association was strongest in the youngest children (5 years) and at children's hospitals. For pyloromyotomy patients, urban hospitals were associated with reduced odds of any complication (OR=0.43, 95% C.I. 0.24-0.75), anesthesia-related complications (OR=0.14, 95% C.I. 0.05-0.37), and duodenal perforation (OR=0.46, 95% C.I. 0.19-1.07). These associations were most significant at children's hospitals.Postoperative outcomes appear to be improved at urban specialty hospitals relative to rural hospitals for certain common pediatric procedures. Identification of the factors driving this association may help inform resource optimization efforts in pediatric surgery. |
| Databáze: | OpenAIRE |
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