Impact of hospital size on the outcomes of appendectomy in children: an analysis of a comprehensive nationwide pediatric
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ORIGINAL ARTICLE
Impact of hospital size on the outcomes of appendectomy in children: an analysis of a comprehensive nationwide pediatric dataset Jeik Byun1 · Jin‑Young Min2 · Hee‑Beom Yang3 · Dayoung Ko1 · Hyun‑Young Kim4 · Kyoung‑Bok Min5 · Sung Eun Jung4 Received: 4 March 2020 / Accepted: 17 May 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purposes The purpose of this study was to investigate the outcomes after appendectomy in children according to hospital size. Methods The records of 11,565 patients with the diagnosis-related group code for appendectomy were extracted from HIRA-Pediatric Patient Sample from 2012 to 2016. The number of hospital visits and the length of stay in hospital within 30 days after appendectomy were analyzed. Results Patients who were treated at large-sized hospitals were more likely to be younger, more likely to reside in metropolitan areas, and tended to receive laparoscopic surgery. The number of hospital visits within 30 days in patients managed by medium- and large-sized hospitals decreased in comparison to small-sized hospitals. The length of hospital stay in large-sized hospitals was decreased in comparison to small- and medium-sized hospitals. A subgroup analysis revealed that complicated appendectomy did not have a significant impact on the difference in the length of hospital stay between hospital sizes. Conclusion The number of hospital visits and the length of hospital stay was higher in small-sized hospitals in comparison to large-sized hospitals. Appendectomy performed in the larger hospital showed better outcomes in pediatric patients. We recommend that pediatric surgical procedures be performed in large hospitals, and that proper incentives be given for procedures to be performed by pediatric specialists. Keywords Appendectomy · Pediatric · Hospital size · Children · Appendicitis
Introduction Jeik Byun and Jin-Young Min equally contributed this work. * Hyun‑Young Kim [email protected] * Kyoung‑Bok Min [email protected] 1
Department of Pediatric Surgery, Seoul National University Children’s Hospital, Seoul, Korea
2
Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea
3
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
4
Department of Pediatric Surgery, College of Medicine, Seoul National University, 101, Daehak‑ro, Jongno‑gu, Seoul 03080, Korea
5
Department of Preventive Medicine, College of Medicine, Seoul National University, 101, Daehak‑ro, Jongno‑gu, Seoul 03080, Korea
Several studies have reported that in pediatric patients, the outcomes of surgery performed by a pediatric specialist are superior to the outcomes of surgery performed by general surgeons [1–4]. However, some have suggested that for lowrisk procedures like appendectomy, there outcomes do not differ between pediatric specialists and general surgeons [5–8]. Since McBurney first reported appendectomy for acute appendicitis in 1889 [9], it has been one of the most common proced
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