Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals

Tom, Cynthia M.; Won, Roy P.; Lee, Alexander D.; Friedlander, Scott; Sakai‐Bizmark, Rie; Lee, Steven L.

doi:10.1016/j.jss.2018.06.021

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…Many previous studies have shown higher charges or costs at CHs versus NCHs for all pediatric inpatients, 28 pediatric asthma, 29,30 severe pediatric sepsis, 31 and common surgical procedures. [32][33][34][35][36][37] Some show equivalent outcomes regardless of hospital type, such as for malrotation surgery 38 and neonatal herpes simplex. 7 Others show poorer outcomes at non-CHs, such as increased LOS and complications with pyloromyotomy.…”

Section: Discussionmentioning

confidence: 99%

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Ahuja

Mack

Russell

2020

Hospital Pediatrics

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BACKGROUND AND OBJECTIVE: Technology-dependent children (TDC) are admitted to both children's hospitals (CHs) and nonchildren's hospitals (NCHs), where there may be fewer pediatricspecific specialists or resources. Our objective was to compare the characteristics of TDC admitted to CHs versus NCHs.METHODS: This was a multicenter, retrospective study using the 2012 Kids' Inpatient Database. We included patients aged 0 to 18 years with a tracheostomy, gastrostomy, and/or ventricular shunt. We excluded those who died, were transferred into or out of the hospital, had a length of stay (LOS) that was an extreme outlier, or had missing data for key variables. We compared patient and hospital characteristics across CH versus NCH using x 2 tests and LOS and cost using generalized linear models. RESULTS:In the final sample of 64 521 discharges, 55% of discharges of TDC were from NCHs. A larger proportion of those from CHs had higher disease severity (55% vs 49%; P , .001) and a major surgical procedure during hospitalization (28% vs 24%; P , .001). In an adjusted generalized linear model, the mean LOS was 4 days at both hospital types, but discharge from a CH was associated with a higher adjusted mean cost ($16 754 vs $12 023; P , .001). CONCLUSIONS:Because the majority of TDC are hospitalized at NCHs, future research on TDC should incorporate NCH settings. Further studies should investigate if some may benefit from regionalization of care or earlier transfer to a CH.

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Section: Discussionmentioning

confidence: 99%

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Ahuja

Mack

Russell

2020

Hospital Pediatrics

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“…17 In Germany; Gosemann et al 18 found that of 8110 pediatric appendectomies, 75% were performed using laparoscopy. In 2018, in a wide-ranging study, Tom et al 19 found that of the 58511 appendectomies conducted in children’s hospitals in the USA between 2003 and 2012, 70% were done using laparoscopy, compared to 53% of the ∼1.2 million conducted at non-children’s hospitals. Zani et al 20 summarized the results of the European Pediatric Surgeons’ Association survey on the management of pediatric appendicitis, compiled from 169 respondents from 42 countries (24 European).…”

Section: Discussionmentioning

confidence: 99%

Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

Hannan¹,

Parveen

Nandy

2020

Preprint

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Background: Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. Objective: The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. Methods: This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital, Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. Results: The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). Conclusions: Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.

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“…In Germany, Gosemann et al [19] found that of 8110 pediatric appendectomies, 75% were performed using laparoscopy. In 2018, in a wide-ranging study, Tom et al [20] found that of the 58,511 appendectomies conducted in children's hospitals in the United States between 2003 and 2012, 70% were done using laparoscopy, compared to 53% of the ~1.2 million conducted at nonchildren's hospitals. Zani et al [21] summarized the results of the European Pediatric Surgeons' Association survey on the management of pediatric appendicitis, compiled from 169 respondents from 42 countries (24 European countries).…”

Section: Discussionmentioning

confidence: 99%

Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series (Preprint)

Hannan¹,

Parveen²,

Nandy³

et al. 2020

Preprint

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BACKGROUND to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. OBJECTIVE The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. METHODS This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. RESULTS The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). CONCLUSIONS Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.

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Outcomes and Costs of Common Surgical Procedures at Children's and Nonchildren's Hospitals

Cited by 10 publications

References 29 publications

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Technology-Dependent Pediatric Inpatients at Children’s Versus Nonchildren’s Hospitals

Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

Use of Spinal Anesthesia in Pediatric Laparoscopic Appendectomies: Case Series (Preprint)

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