Clinical and financial characteristics of pediatric surgery practices

Nakayama, Don K.; Burd, Randall S.; Newman, Kurt D.

doi:10.1016/j.jpedsurg.2009.02.003

Cited by 16 publications

(12 citation statements)

References 12 publications

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“…The pediatric surgery workforce has been closely monitored by American pediatric surgery organizations since 1975. 13,[24][25][26][27] The surgical workforce is critically important when contemplating healthcare reform, physician training numbers, centralization of pediatric surgery care, and physician geographic distribution. The concomitant development of several maternal-fetal surgical centers throughout the United States suggests that regionalization to such centers may be necessary to ensure optimal maternal as well as fetal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…There is a high concentration of pediatric surgeons at pediatric surgery referral centers; such institutions are often universitybased children' s hospitals, and typically these are often located in a metropolitan area. 13,[24][25][26][27] There remain "surgical deserts": counties in the United States where there are neither general nor pediatric surgeons in practice. 29 The lack of pediatric surgeons in rural areas may contribute to pediatric surgery being performed at the local general hospital by general surgeons without subspecialty training.…”

Section: Discussionmentioning

confidence: 99%

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Frequency and Variety of Inpatient Pediatric Surgical Procedures in the United States

et al. 2013

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OBJECTIVE: Pediatric surgical procedures are being performed in a variety of hospitals with large differences in surgical volume. We examined the frequency and variety of inpatient pediatric surgical procedures in the United States by hospital type and geographic region using a nationally representative sample. METHODS: The 2009 Kids’ Inpatient Database for patients <18 years old was used to calculate surgical frequencies by using International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) codes. We performed stratified analysis by hospital type (free-standing children’s hospital, children’s unit within an adult hospital, and general hospital) and geographic region (South, West, Midwest, Northeast) to compare frequencies of surgical procedures. RESULTS: A total of 216 081 procedures were projected for 2009 with the top 20 procedures accounting for >90% of cases. As many as 40% of all pediatric inpatient surgical procedures are being performed in adult general hospitals. Infrequent complex low-volume neonatal surgical procedures (pullthrough for Hirschsprung disease, surgery for malrotation, esophageal atresia repair, and diaphragmatic hernia repair) were 6.8 to 16 times more likely to occur in a children's hospital. Significant regional variation in procedure frequency rates occurred for appendectomy and cholecystectomy. CONCLUSIONS: This report is the first to characterize pediatric surgical inpatient volume in the United States. Such data may influence the distribution of pediatric surgeons, number of trainees, and training curricula for pediatric surgeons, pediatricians, general surgeons and other surgical specialists who might operate on children. In addition, it raises the question of whether complex pediatric surgical procedures should preferably be performed at dedicated high volume children's hospitals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequency and Variety of Inpatient Pediatric Surgical Procedures in the United States

et al. 2013

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“…In their replies, they mentioned inguinal, umbilical hernias; abscesses and trauma. Nearly 20% of the respondents expressed interest to count on a PedSur partner who would substitute them in their surgical procedures [4].…”

Section: Introductionmentioning

confidence: 99%

“…Routine surgeries showed a slight difference between training programs, as well as experience among surgeons. There are services in which PedSur iconic surgeries, such as esophagus atresia, bile duct atresia, and inter-sex atresia are scarce or not performed in some training programs [4]. In spite of this upturn in PedSur programs, it doesn't seem that they have significantly affected the exposure to and surgical experience in highly specific specialties.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Study of Pediatric Surgery at Regional Hospital of Sorocaba between 2008 and 2012 by a Single Surgeon

Rosalino¹,

Martelli²,

Novo³

et al. 2017

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Introduction: volume increase of Pediatric Surgery (PedSur) due to factors not yet fully clarified contrast with the scarcity of pediatric surgeons in Brazil and globally. Geographic distribution, surgical care costs, and graduation period might contribute to this dearth. In Brazil, vacancy occupation rate in PedSur is below 43% ( Surgery was carried out in 667 (68%) boys and 319 (32%) girls. Hernias, appendectomies and circumcisions were the most frequent external surgeries. 437 (44%) patients were discharged on the same day and, 549 (56%) were hospitalized. In the Pediatric ICU and in the Neonatal ICU 181 procedures were performed (18%). Conclusion: It was possible to make evident the distribution of surgeries on children, the degree of complexity and a sufficient number of subjects for training in this Specialty. The obtained data allow the development of a study with regards to the inception of a Medical Residence in PedSur at HR for training and retaining the professional in the region.

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“…The financial value of pediatric surgery in a university is poorly understood. Moreover, the revenue streams that support university pediatric surgery are not limited to professional fees, although increasingly, private practice/ fee-for-service is augmented by contractual arrangements with a hospital [1]. In the current era of contracting fees for service, diversification of revenue streams is an increasingly vital business model.…”

mentioning

confidence: 99%