Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network

Baird, Robert; Eeson, Gareth; Safavi, Arash; Puligandla, Pramod S.; Laberge, Jean-Martin; Skarsgard, Erik D.

doi:10.1016/j.jpedsurg.2011.02.008

Cited by 70 publications

(35 citation statements)

References 18 publications

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“…Similar to cardiac studies, hospital volume was consistently defined as annual caseload and mortality was the primary outcome. Three CDH studies 8,49,50 used a well-established Canadian database, and the fourth study 51 used a national US administrative database. These studies generally reported significantly decreased mortality at highervolume hospitals.…”

Section: General Surgerymentioning

confidence: 99%

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

McAteer¹,

LaRiviere²,

Drugas³

et al. 2013

JAMA Pediatr

125

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Importance: Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.Objective: To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.Evidence Review: A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted.Findings: Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures.Conclusions and Relevance: Data on experiencerelated outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies should seek both to standardize definitions, making results more applicable, and to differentiate procedures affected by surgeon experience from those more affected by hospital resources and system-level variables.

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Section: General Surgerymentioning

confidence: 99%

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

McAteer¹,

LaRiviere²,

Drugas³

et al. 2013

JAMA Pediatr

125

View full text Add to dashboard Cite

show abstract

“…More than 90% patients are diagnosed antenatally using ultrasound (Baird et al 2011, Garne et al 2010. The typical sonographic feature is multiple loops of bowel floating freely in the amniotic fluid after the time of normal embryonic return of the intestines to the abdominal cavity (10 weeks of gestation).…”

Section: Gastroschisismentioning

confidence: 99%

“…Survival rate of neonates with gastroschisis is high (93-97%) (Abdel-Latif et al 2008, Baird et al 2011, Owen et al 2010. The median time to discharge home range between 23 to 47 days , Baird et al 2011, infants with short gut syndrome have very prolonged hospitalisation with the risk of complications of prolonged TPN therapy such as cholestasis and recurrent infections.…”

Section: Gastroschisismentioning

confidence: 99%

“…The median time to discharge home range between 23 to 47 days , Baird et al 2011, infants with short gut syndrome have very prolonged hospitalisation with the risk of complications of prolonged TPN therapy such as cholestasis and recurrent infections. Limited information available on the physical growth and neurodevelopmental outcomes suggests that treated infants have a good long term prognosis , Henrich et al 2008).…”

Section: Gastroschisismentioning

confidence: 99%

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Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

Rao¹,

Ravikumara²,

Simmer³

2012

Neonatal Care

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“…The complex interplay of roles between specialists and the lack of evidence informing "best practices" across the phases of care leads to substantial practice and outcome variation within and between children's hospitals in Canada. 4 This unwanted variation in clinical care contributes to suboptimal outcomes and inefficiencies in use of health care resources.…”

mentioning

confidence: 99%

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Puligandla¹,

Skarsgard²,

Offringa³

et al. 2018

CMAJ

Self Cite

193

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Institutional practice and outcome variation in the management of congenital diaphragmatic hernia and gastroschisis in Canada: a report from the Canadian Pediatric Surgery Network

Cited by 70 publications

References 18 publications

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery

Recent Advances in Neonatal Gastroenterology and Neonatal Nutrition

Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

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