Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals

Cynthia M Tom; Roy P Won; Alexander D Lee; Scott Friedlander; Rie Sakai-Bizmark; Steven L Lee

doi:10.1016/j.jss.2018.06.021

Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals

J Surg Res. 2018 Dec:232:63-71. doi: 10.1016/j.jss.2018.06.021. Epub 2018 Jul 3.

Authors

Cynthia M Tom¹, Roy P Won¹, Alexander D Lee¹, Scott Friedlander², Rie Sakai-Bizmark², Steven L Lee³

Affiliations

¹ Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.
² Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California; Los Angeles Biomedical Research Institute, Torrance, California.
³ Department of Surgery, Harbor-UCLA Medical Center, Torrance, California; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California; Los Angeles Biomedical Research Institute, Torrance, California. Electronic address: stevenlee@mednet.ucla.edu.

PMID: 30463784
DOI: 10.1016/j.jss.2018.06.021

Abstract

Background: Variations in the management of pediatric patients at children's hospitals (CHs) and non-CHs (NCHs) have been well described, especially within the trauma literature. However, little is known about the outcomes and costs of common general surgical procedures at NCHs. The purpose of this study was to evaluate the effect of CH designation on the outcomes and costs of appendectomy and cholecystectomy.

Methods: The Kids' Inpatient Database (2003-2012) was queried for patients aged under 18 y who underwent appendectomy or cholecystectomy at CHs and NCHs. Outcomes analyzed included disease severity, complications, laparoscopy, length of stay (LOS), and cost.

Results: Most of appendectomies and cholecystectomies were performed at NCHs. Overall, CHs cared for younger children were more likely to be teaching hospitals, had higher costs, and longer LOS. On multivariate analysis for appendectomies, CHs were associated with higher rates of perforated appendicitis (OR = 1.53, 95% CI = 1.42-1.66, P < 0.001), less complications (OR = 0.68, 95% CI = 0.61-0.75, P < 0.001), increased laparoscopy (OR = 2.93, 95% CI = 2.36-3.64, P < 0.001), longer LOS (RR = 1.13, 95% CI = 1.09-1.17, P < 0.001), and higher costs (exponentiated log $ = 1.19, 95% CI = 1.13-1.24, P < 0.001). Multivariate analysis for cholecystectomies revealed that CHs were associated with less laparoscopy (OR = 0.58, 95% CI = 0.50-0.67, P < 0.001), longer LOS (RR = 1.26, 95% CI = 1.19-1.34, P < 0.001), and higher costs (exponentiated log $ = 1.29, 95% CI = 1.22-1.37, P < 0.001) with similar complications. Independent predictors of LOS and cost included CH designation, negative appendectomy, perforated appendicitis, complications, younger age, black patients, and public insurance.

Conclusions: Variations in surgical management, outcomes, and costs after appendectomy and cholecystectomy exist between CHs and NCHs. CHs excelled in treating complicated appendicitis. NCHs effectively performed cholecystectomies. These differences in outcomes require further investigation to identify modifiable factors to optimize care across all hospitals for these common surgical diseases.

Keywords: Children's hospital; Costs; Nonchildren's hospital; Outcomes; Pediatric appendicitis; Pediatric cholecystectomy.

MeSH terms

Adolescent
Appendectomy / adverse effects
Appendectomy / economics*
Child
Child, Preschool
Cholecystectomy / adverse effects
Cholecystectomy / economics*
Female
Health Care Costs*
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Laparoscopy
Length of Stay
Male
Postoperative Complications / epidemiology