Hospital volumes for common pediatric specialty operations

Arch Pediatr Adolesc Med. 2007 Jan;161(1):38-43. doi: 10.1001/archpedi.161.1.38.


Objectives: To describe hospital volumes for common pediatric specialty operations, to evaluate hospital and patient characteristics associated with operations performed at a low-volume hospital, and to evaluate outcomes with hospital volume.

Design: Retrospective cohort using the Kids' Inpatient Database 2003.

Setting: Discharges from 3438 hospitals in 36 states from 2003.

Participants: Children aged 0 to 18 years undergoing ventriculoseptal defect surgery (n = 2301), tracheotomy (n = 2674), ventriculoperitoneal shunt placement (n = 3378), and posterior spinal fusion (n = 4002).

Main exposure: Hospital volume.

Main outcome measures: In-hospital mortality and postoperative complications.

Results: For tracheotomy and posterior spinal fusion, at least one fourth of the hospitals performed only 1 operation for children aged 0 to 18 years in 2003. For these same operations, at least half of hospitals treated 4 or fewer cases per year. For all operations, discharges from low-volume hospitals were less likely to be from children's or teaching hospitals compared with discharges from higher-volume hospitals. For tracheotomy, children were less likely to experience postoperative complications in high-volume hospitals compared with low-volume hospitals (odds ratio, 0.48; 95% confidence interval, 0.21-1.09).

Conclusions: Many children undergoing common pediatric specialty operations had these procedures performed in low-volume hospitals. Low-volume hospitals were less likely to be children's or teaching hospitals. Children undergoing tracheotomy experienced higher rates of complications in low-volume hospitals. Further research is needed to identify the reasons why so many children have these operations performed in low-volume hospitals.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Cardiac Surgical Procedures / statistics & numerical data*
  • Child
  • Child, Preschool
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular / surgery
  • Hospital Mortality / trends
  • Hospitals, Pediatric / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Spinal Fusion / statistics & numerical data*
  • Tracheotomy / statistics & numerical data*
  • United States
  • Ventriculoperitoneal Shunt / statistics & numerical data*