Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis

Am J Surg. 2017 Mar;213(3):502-506. doi: 10.1016/j.amjsurg.2016.11.014. Epub 2016 Nov 9.

Abstract

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.

Keywords: Care delivery microenvironment; NEC; Necrotizing enterocolitis; Pediatric surgery; Surgical outcomes.

MeSH terms

  • Cross-Sectional Studies
  • Enterocolitis, Necrotizing / mortality*
  • Enterocolitis, Necrotizing / surgery*
  • Female
  • Hospitals, High-Volume*
  • Hospitals, Low-Volume*
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Retrospective Studies
  • United States / epidemiology
  • Workforce