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Frequency and variety of inpatient pediatric surgical procedures in the United States.
[hirschsprung disease]
Pediatric
surgical
procedures
are
being
performed
in
a
variety
of
hospitals
with
large
differences
in
surgical
volume
.
We
examined
the
frequency
and
variety
of
inpatient
pediatric
surgical
procedures
in
the
United
States
by
hospital
type
and
geographic
region
using
a
nationally
representative
sample
.
The
2009
Kids
'
Inpatient
Database
for
patients
<
18
years
old
was
used
to
calculate
surgical
frequencies
by
using
International
Classification
of
Diseases
,
Ninth
Revision
,
Clinical
Modification
,
(
ICD-
9
-
CM
)
codes
.
We
performed
stratified
analysis
by
hospital
type
(
free-standing
children
's
hospital
,
children
's
unit
within
an
adult
hospital
,
and
general
hospital
)
and
geographic
region
(
South
,
West
,
Midwest
,
Northeast
)
to
compare
frequencies
of
surgical
procedures
.
A
total
of
216
081
procedures
were
projected
for
2009
with
the
top
20
procedures
accounting
for
>
90
%
of
cases
.
As
many
as
40
%
of
all
pediatric
inpatient
surgical
procedures
are
being
performed
in
adult
general
hospitals
.
Infrequent
complex
low
-volume
neonatal
surgical
procedures
(
pullthrough
for
Hirschsprung
disease
,
surgery
for
malrotation
,
esophageal
atresia
repair
,
and
diaphragmatic
hernia
repair
)
were
6
.
8
to
16
times
more
likely
to
occur
in
a
children
's
hospital
.
Significant
regional
variation
in
procedure
frequency
rates
occurred
for
appendectomy
and
cholecystectomy
.
This
report
is
the
first
to
characterize
pediatric
surgical
inpatient
volume
in
the
United
States
.
Such
data
may
influence
the
distribution
of
pediatric
surgeons
,
number
of
trainees
,
and
training
curricula
for
pediatric
surgeons
,
pediatricians
,
general
surgeons
and
other
surgical
specialists
who
might
operate
on
children
.
In
addition
,
it
raises
the
question
of
whether
complex
pediatric
surgical
procedures
should
preferably
be
performed
at
dedicated
high
volume
children
's
hospitals
.
Diseases
Validation
Diseases presenting
"pediatric surgical procedures"
symptom
hirschsprung disease
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