Volume-outcome Effects for Children Undergoing Resection of Renal Malignancies

Overview

Journal J Surg Res

Specialty General Surgery

Date 2012 May 1

PMID 22541281

Citations 1

Authors

Jason R Axt

Andrew J Murphy

Patrick G Arbogast

Harold N Lovvorn 3rd

Affiliations

Soon will be listed here.

Abstract

Introduction: Adults undergoing oncologic resections at low-volume centers experience increased perioperative morbidity and mortality. The volume-outcome effect has not been extensively studied in pediatric oncologic resections.

Methods: To clarify volume-outcome effects in pediatric oncologic resections, we analyzed resection of renal malignancies in children less than 15 y of age. We conducted a cross-sectional analysis of hospital discharges included in the health care utilization project kids' inpatient database from 1997 to 2009, examining in-hospital operative complications, length of stay (LOS), and inflation-adjusted hospital charges. Hospital volume was expressed as low (n = 1-2), medium (n = 3-4), and high (n > 4) annual volume of resections.

Results: One thousand five hundred thirty-eight patients underwent renal malignancy resection. Of these, 527 patients had resection in low-, 422 in medium-, and 589 in high-volume hospitals. Relative to low-volume hospitals, those resected in medium-volume hospitals had an odds ratio of 0.62 (95% confidence interval 0.39-0.99, P = 0.046) for operative complication and those in high-volume hospitals had an odds ratio of 1.02 (95% confidence interval 0.63-1.65, P = 0.95). There was no detectable association with LOS (P = 0.113) or inflation-adjusted charges (P = 0.331).

Conclusions: The number of complications, total charges, and LOS attributable to resection of a childhood renal malignancy did not differ among high-, medium-, or low-operative volume hospitals, although oncologic outcomes could not be determined because of the limited nature of this administrative database.

Citing Articles

Health disparities are important determinants of outcome for children with solid tumor malignancies.

Austin M, Nguyen H, Eberth J, Chang Y, Heczey A, Hughes D J Pediatr Surg. 2015; 50(1):161-6.

PMID: 25598116 PMC: 4408987. DOI: 10.1016/j.jpedsurg.2014.10.037.

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