Variations in inpatient pediatric anesthesia in California from 2000 to 2009: a caseload and geographic analysis. Issue 12 (9th September 2014)

• Record Type: Journal Article
• Authors: Mudumbai, Seshadri C.; Honkanen, Anita; Chan, Jia; Schmitt, Susan; Saynina, Olga; Hackel, Alvin; Gregory, George; Phibbs, Ciaran S.; Wise, Paul H.; Anderson, Brian
• Is Part Of: Paediatric anaesthesia. Volume 24:Issue 12(2014)
• Page Start: 1295
• Page End: 1301
• Publication Date: 2014-09-09
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12500
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12500-abs-0001"> <title>Summary</title> <sec id="pan12500-sec-0001" sec-type="section"> <title>Background</title> <p>Regional referral systems are considered important for children hospitalized for surgery, but there is little information on existing systems.</p> </sec> <sec id="pan12500-sec-0002" sec-type="section"> <title>Objectives</title> <p>To examine geographic variations in anesthetic caseloads in California for surgical inpatients ≤6 years and to evaluate the feasibility of regionalizing anesthetic care.</p> </sec> <sec id="pan12500-sec-0003" sec-type="section"> <title>Methods</title> <p>We reviewed California's unmasked patient discharge database between 2000 and 2009 to determine surgical procedures, dates, and inpatient anesthetic caseloads. Hospitals were classified as urban or rural and were further stratified as low, intermediate, high, and very high volume.</p> </sec> <sec id="pan12500-sec-0004" sec-type="section"> <title>Results</title> <p>We reviewed 257 541 anesthetic cases from 402 hospitals. Seventeen California Children's Services (CCS) hospitals conducted about two‐thirds of all inpatient anesthetics; 385 non‐CCS hospitals accounted for the rest. Urban hospitals comprised 82% of low‐ and intermediate‐volume centers (<italic>n</italic> = 297) and 100% of the high‐ and very high‐volume centers (<italic>n</italic> = 41). Ninety percent (<italic>n</italic> = 361) of hospitals performed <100 cases annually. Although potentially lower risk procedures such as appendectomies were the most frequent in urban low‐ and intermediate‐volume hospitals, fairly complex neurosurgical and general surgeries were also performed. The median distance from urban lower‐volume hospitals to the nearest high‐ or very high‐volume center was 12 miles. Up to 98% (<italic>n</italic> = 40 316) of inpatient anesthetics at low‐ or intermediate‐volume centers could have been transferred to higher‐volume centers within 25 miles of smaller centers.</p> </sec> <sec id="pan12500-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Many urban California hospitals maintained low annual inpatient anesthetic caseloads for children ≤6 years while conducting potentially more complex procedures. Further efforts are necessary to define the scope of pediatric anesthetic care at urban low‐ and intermediate‐volume hospitals in California.</p> </sec> </abstract>