Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis
| Autor: | Adrienne N. Cobb, Yoshiki Ezure, Paul C. Kuo, Heather N. Paddock, Yee M. Wong, Anai N. Kothari, Barbara A. Blanco, Sarah A. Brownlee |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Hospitals Low-Volume Logistic regression Article 03 medical and health sciences 0302 clinical medicine Enterocolitis Necrotizing Intensive Care Units Neonatal 030225 pediatrics Pediatric surgery Humans Medicine 030212 general & internal medicine Intensive care medicine Retrospective Studies business.industry Mortality rate Infant Newborn Infant General Medicine Perioperative Risk adjustment medicine.disease United States Low volume Cross-Sectional Studies Increased risk Necrotizing enterocolitis Emergency medicine Workforce Female Surgery business Hospitals High-Volume |
| Zdroj: | The American Journal of Surgery. 213:502-506 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2016.11.014 |
| Popis: | Background This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes. Methods A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates. Results 23 hospitals with 618 patients undergoing NEC-related surgical intervention were included. Overall mortality rate was 22.5%. There were no significant differences in the number of NICU beds (p = 0.135) or NICU intensivists (p = 0.469) between high and low volume hospitals. Following risk adjustment, no difference in mortality rate was observed between high and low volume hospitals respectively (24.0% vs. 20.3%, p = 0.555). Conclusions Our observation that neonates with NEC treated at low-volume centers have no increased risk of mortality may be explained by similar availability of NICU and intensivists resources across hospitals. |
| Databáze: | OpenAIRE |
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