Study objective: To examine the demographics of inpatient anesthesia care for infants and children in a specific region to determine if there were sufficient numbers of procedures to permit credentialing to take place, as a first step in understanding the consequences of implementing credentialing policies based on caseload.
Design: Retrospective computerized review of discharge abstracts.
Setting: All hospitals in northern California.
Measurements and main results: Surgical procedures and date of surgery were linked to create "procedure-days." Each procedure-day counted as one anesthesia case. Annual hospital caseloads (procedure-days) were tabulated for three separate age subgroups under six years of age. The proximity of hospitals with smaller surgical volumes to those with larger volumes was determined. Of the 205 hospitals in the region, 162 had at least one procedure-day for children less than 6 years of age for a total of 14,435 procedure-days (anesthesia cases). For each of three age groups studied--0 to 6 months, 7 to 24 months, and 25 to 72 months--85%, 90%, and 81%, respectively, of hospitals had caseloads of 1 to 50 per year. When procedure days from all three age groups were totalled, 59% of hospitals had less than 20 cases per year and 72% of hospitals had less than 50 cases per year; 86% of hospitals had less than 100 cases per year. Of hospitals with less than 100 cases per year, 75% were within 50 miles of a hospital with more than 100 cases.
Conclusions: Performance based credentialing for pediatric anesthesia based on caseload may be problematic for many hospitals due to the distribution of cases: a majority of hospitals care for a few children, and most children are cared for in a few hospitals.