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Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis

  • RESEARCH
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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

This study aimed to examine the association between hospital volume and postoperative outcomes in pediatric major surgery using a nationwide database. The study included pediatric patients who underwent first major elective inpatient surgery and hospitalization for more than 1 day. The results showed no significant difference in the risk of 30-day postoperative mortality based on hospital volume. However, patients in the middle- and high-volume groups had significantly lower rates of 30-day major complications, particularly deep wound infection. In terms of 90-day postoperative outcomes, patients in the high-volume group had a significantly lower risk of mortality and lower rates of major complications, particularly deep wound infection, pneumonia, and septicemia.

  Conclusions: The study suggests that pediatric patients undergoing major surgery in high and middle-volume groups have better outcomes in terms of major complications compared to the low-volume group.

What is Known:

• Limited evidence exists on the connection between hospital volume and pediatric surgery outcomes.

What is New:

• A Taiwan-based study, using national data, found that high and middle hospital-volume groups experienced significantly lower rates of major complications within 30 and 90 days after surgery.

• High-volume hospitals demonstrated a substantial decrease in the risk of 90-day postoperative mortality.

• The study underscores the importance of specialized pediatric surgical centers and advocates for clear guidelines for hospital selection, potentially improving outcomes and informing future health policies.

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Availability of data and materials

The datasets that support the study’s conclusions are included in the manuscript. However, due to the Personal Information Protection Act executed by Taiwan's government in 2012, some access restrictions apply to the data underlying the findings. Researchers interested in accessing the data may submit a formal proposal to obtain approval from the ethics review committee of the appropriate governmental department in Taiwan. Links for data requests are as follows: NHIRD Data Subsets and NHIS Data Request. Informed consent for data usage was waived because the datasets are covered under the Personal Information Protection Act.

Abbreviations

OR:

Odds ratio

aOR:

Adjusted odds ratio

CI:

Confidence interval

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

ICD-10-CM:

International Classification of Diseases, Tenth Revision, Clinical Modification

NHIRD:

National Health Insurance Research Database

ASA:

American Society of Anesthesiology

SD:

Standard deviation

IQR:

Interquartile range

NHI:

National Health Insurance

CCI:

Charlson Comorbidity Index

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Funding

This research received financial support from the Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, for Szu-Yuan Wu's work, with funding numbers 11001, 11,010, 11,013, and 11,103. This work was supported by the Henan Young and middle-aged health academic leader Project (Nos.CYQ20210026 to Jiaqiang Zhang and Nos. CYQ20220019 to Mingyang Sun).

Author information

Author notes

  1. Mingyang Sun, Szu-Yuan Wu, and Jiaqiang Zhang have contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Mingyang Sun & Jiaqiang Zhang

  2. Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan

    Wan-Ming Chen & Szu-Yuan Wu

  3. Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan

    Wan-Ming Chen & Szu-Yuan Wu

  4. Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan

    Szu-Yuan Wu

  5. Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan

    Szu-Yuan Wu

  6. Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan

    Szu-Yuan Wu

  7. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan

    Szu-Yuan Wu

  8. Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St.Yilan County 265, Luodong Township, Taiwan

    Szu-Yuan Wu

  9. Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Szu-Yuan Wu

  10. Department of Management, College of Management, Fo Guang University, Yilan, Taiwan

    Szu-Yuan Wu

Authors
  1. Mingyang Sun
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  2. Wan-Ming Chen
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Contributions

Conception and design: MS, W-MC, S-YW, JZ Financial support: Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports Szu-Yuan Wu’s work (Funding Number: 11001, 11010, 11013, and 11103). Collection and assembly of data: S-YW, JZ Data analysis and interpretation: JZ, S-YW Administrative support: S-YW* Manuscript writing: MS, W-MC, S-YW, JZ Final approval of manuscript: all authors.

Corresponding authors

Correspondence to Szu-Yuan Wu or Jiaqiang Zhang.

Ethics declarations

Ethical approval

Ethical approval for this study was obtained from the Institutional Review Board of Tzu-Chi Medical Foundation (IRB109-015-B). This study was conducted in accordance with the ethical principles outlined in the Personal Information Protection Act of Taiwan, which has been in effect since 2012. The waiver of informed consent by the IRB/Ethics Committee was granted based on the protected status of the data sets used, namely the National Health Insurance Research Database and Taiwan Cancer Registry database. Access to these data sources is restricted under the act, and therefore, the data used in this study cannot be publicly available in the manuscript or supplemental files. However, interested parties may request access to the data by submitting a formal proposal to the ethics review committee of the relevant governmental department in Taiwan. For detailed contact information and instructions for data access requests, please refer to the following URLs: http://nhird.nhri.org.tw/en/Data_Subsets.html#S3 and http://nhis.nhri.org.tw/point.html. It should be noted that Szu-Yuan Wu, MD, PhD, had complete access to all data in the study and assumes full responsibility for ensuring the integrity and accuracy of the data. The study adheres to the guidelines set forth by the ethical standards of the mentioned act, ensuring the protection and privacy of the participants' information.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

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Summary

There is a paucity of rigorous evidence to support the association between hospital volume and postoperative outcomes in pediatric surgery. This study evaluated the relationship between hospital volume and postoperative outcomes in pediatric major surgery using a nationwide database in Taiwan. The results showed that patients in high and middle hospital-volume groups had lower rates of 30-day and 90-day major complications, particularly deep wound infection, pneumonia, and septicemia. Additionally, the high hospital-volume group had a significantly lower risk of 90-day 4 postoperative mortality. The study emphasizes the importance of specialized pediatric surgical centers and establishing clear guidelines for hospital volume and selection in pediatric surgery to optimize outcomes and inform future health policies.

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Sun, M., Chen, WM., Wu, SY. et al. Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis. Eur J Pediatr 183, 619–628 (2024). https://doi.org/10.1007/s00431-023-05308-2

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  • DOI: https://doi.org/10.1007/s00431-023-05308-2

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