Cleft-Palate Repair: Does Hospital Case-Volume Impact Outcomes or Cost?

Wes, Ari M.; Mazzaferro, Daniel M.; Naran, Sanjay; Bartlett, Scott P.; Taylor, Jesse A.

doi:10.1097/prs.0000000000004292

Cited by 17 publications

(19 citation statements)

References 40 publications

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“…This trend has been seen in various general surgery and plastic surgery procedures 23–26 . However, when analyzing other craniofacial procedures, a national study on cleft palate repair was unable to demonstrate associations between hospital volume and costs 27 . Some of this could be attributed to case-mix index and severity of cleft pathology treated at higher volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

Kalmar

Chaker

Pontell

et al. 2023

Journal of Craniofacial Surgery

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Background: LeFort I osteotomy (LF1) and bilateral sagittal split osteotomy (BSSO) have unique operative challenges and inherent anatomic considerations that predispose to certain adverse outcomes, yet their respective complication profiles continue to be debated given conflicting results from single-center investigations. The purpose of this study is to perform a multi-institutional analysis of complications, socioeconomic trends, and financial charges associated with orthognathic surgery. Methods: A retrospective cohort study was conducted of orthognathic procedures performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Patients younger than 12 years of age were excluded. Medical complications, surgical complications, and admission costs were compared across procedures. Socioeconomic determinants and trends across regions of the country were also analyzed. Results: During the study interval, 6640 patients underwent orthognathic surgery, including LF1 (59.2%, n=3928), BSSO (14.4%, n=959), and double-jaw surgery (26.4%, n=1753). Patients undergoing LF1 were more likely to experience overall complications (P<0.001), infections (P<0.001), and blood transfusions (P<0.001) than those undergoing BSSO. High-volume hospitals were more likely to perform double-jaw procedures than other hospitals (P<0.001), yet high-volume hospitals were less likely to have surgical complications (P=0.014). Patient admission charges related to orthognathic operations at high-volume hospitals were less than other hospitals (P<0.001). Household income was higher for orthognathic procedures performed at high-volume hospitals (P<0.001). White patients were 1.5 times more likely to choose a farther, higher volume hospital for orthognathic surgery than the one locally available (P=0.041). Conclusions: LeFort I osteotomy procedures had higher infection and transfusion rates than BSSO procedures. High-volume hospitals were more likely to perform double-jaw procedures, yet high-volume hospitals had fewer complications and decreased admission charges. Future study will be needed to further elucidate case-mix index details and socioeconomic determinants of health contributing to these disparities.

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Section: Discussionmentioning

confidence: 99%

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

Kalmar

Chaker

Pontell

et al. 2023

Journal of Craniofacial Surgery

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“…The Pediatric Health Information System database provides comprehensive encounter-level clinical and resource-use data from more than 49 participating children’s hospitals in the United States. 8,12 Nonmedical employees at participating institutions collect and maintain hospital data using the International Classification of Diseases coding system for billing/reimbursement purposes ( International Classification of Diseases, Ninth Revision, Clinical Modification before 2016 and International Classification of Diseases, Tenth Revision, Clinical Modification since 2016). Before inclusion in the Pediatric Health Information System database, hospital data undergo quality control by both the participating hospitals and the Children’s Hospital Association.…”

Section: Methodsmentioning

confidence: 99%

“…These covariates were previously identified as potential or confirmed predictors of the primary outcomes of interest. 8,19,24 980e Plastic and Reconstructive Surgery • June 2021…”

Section: Predictors and Covariatesmentioning

confidence: 99%

A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost

Humphries

Zimmerman

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Local anesthesia is commonly used in a wide range of surgical operations, including plastic and reconstructive procedures, for both adult and pediatric patients. Studies have shown that local anesthesia effectively reduces duration of surgery; decreases postoperative pain, nausea, vomiting, and opioid consumption; and improves cost-effectiveness in orthopedic and minor day surgery. [1][2][3][4] Cleft palate repair contributes a considerable portion of all complications and costs in pediatric plastic surgery. 5,6 Although several studies have

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“…Although hospital volume did not have a significant effect in our study involving PT, higher hospital case volume as a potential protective factor against complications has been studied in different pediatric procedures, such as craniosynostosis, cleft palate repair, and bariatric surgery. 8,[28][29][30] These studies have varied results, and as such, there is not yet a consensus that higher volume hospitals produce fewer complications.…”

Section: No Difference Between High-and Non-highvolume Centersmentioning

confidence: 99%

Hospital volume as a predictor of outcomes following pediatric thyroidectomy

Sasson

Scholfield

et al. 2023

Journal of Surgical Oncology

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Background Pediatric thyroidectomy (PT) is an uncommon procedure with a risk of significant morbidity. This study utilizes a national database to identify factors associated with short‐term (30‐day) post‐thyroidectomy complications in children with thyroid cancer. Methods The 2016 and 2012 Kids' Inpatient Databases (KID) were used in this study. All children with thyroid cancer undergoing thyroidectomy were included. Complications were categorized into endocrine, nervous, pulmonary, and other. Hospital volume was stratified into high‐volume (performing the top 10% of total cases, HVC) or non‐high‐volume centers (NHVC). Risk factors were analyzed using univariable and multivariable statistical tests. Results Six hundred and sixty‐three patients with an average age of 15.93 years met inclusion criteria. Most patients were seen in an NHVC (90.0%) and 37.3% of thyroidectomies were performed with neck dissections. The incidence of any complication was 32.1%. Endocrine complications were the most frequent (32.7%). Independent predictors of any or only endocrine complications were age (odds ratio [OR] = 0.927, p = 0.002, any; OR = 0.926, p = 0.003, endocrine) or concurrent neck dissection (OR = 1.679, p = 0.004, any; OR = 1.683, p = 0.005, endocrine). There was no statistically significant change in odds with hospital volume. Conclusions Further investigation into the effect of single surgeon versus hospital volume on the risk of complications in pediatric thyroid cancer surgery is warranted.

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Cleft-Palate Repair: Does Hospital Case-Volume Impact Outcomes or Cost?

Abstract: Therapeutic, III.

Cited by 17 publications

References 40 publications

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients

A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost

Hospital volume as a predictor of outcomes following pediatric thyroidectomy

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