Operative Volume & Pectus Excavatum Repair Surgical Complications


For a study, researchers sought to determine if procedure-specific provider volume was related to outcomes for patients receiving pectus excavatum repair at tertiary care children’s hospitals. They used the Pediatric Health Information System database to conduct a cohort analysis of patients receiving pectus excavatum repair at children’s hospitals between January 1, 2013, and December 31, 2019. The key exposures were the patient’s hospital’s pectus excavatum repair volume quartile and their surgeon’s pectus excavatum repair volume category. Their primary outcome was a surgical complication diagnosed using the International Classification of Diseases, Ninth Revision, and Clinical Modification codes from the Pediatric Health Information System. Secondary outcomes included expensive admission and a prolonged period of stay.

About 7,183 patients were studied, with an average age of 15.2 years (SD 2.0), 83% male, 74% non-Hispanic White, 68% with no comorbidities, 72% private insurance, and 82% from urban regions. Patients undergoing pectus excavatum repair at hospitals in the second (>10-18 cases/year), third (>18-26 cases/year), and fourth (>26 cases/year) volume quartiles had lower odds of complications of OR 0.52 (CI 0.34-0.82), 0.51 (CI 0.33-0.78), and 0.41 (CI 0.27-0.62), respectively, compared to the lowest-volume (10) quartile. Patients with pectus excavatum who underwent repair by surgeons in the second (>1-5 cases/year), third (>5-10 cases/year), and fourth (>10 cases/year) volume categories had odds of complication of OR 0.91 (CI 0.68-1.20), OR 0.73 (CI 0.51-1.04), and OR 0.55 (CI 0.39-0.76), respectively, when compared to the lowest-volume (one case/year) category. Even among specialist institutions that provided complete patient care, procedure-specific case volume was an essential consideration when selecting a physician for elective surgery.

Reference:www.jpeds.com/article/S0022-3476(21)01260-9/fulltext



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