Effect of surgeon and hospital characteristics on outcome after pyloromyotomy

Background: Previous studies have suggested that the outcome after pyloromyotomy is improved with increased surgeon experience. Others have proposed that infants with pyloric stenosis are best treated by specialty-trained pediatric surgeons or at children's hospitals. Hypothesis: Surgeon and hospital characteristics affect complications, length of stay, and hospital charges after pyloromyotomy. Design: Data for a nationally representative sample of infants (n= 1277) who underwent pyloromyotomy in 2000 in the United States were obtained from the Kids' Inpatient Database. Surgeon and hospital volumes were stratified into quintiles. Multivariate analyses were performed to analyze the impact of surgeon and hospital volume on length of stay, charges, and major operative complications using models that accounted for the hierarchical structure of patient-, surgeon-, and hospital-level covariates. Results: No association between surgeon volume and either length of stay or charges was observed. Higher surgeon volume, however, was associated with fewer complications (P<.001). Surgeons with the highest volume had a 90% lower risk of complications than those with the lowest volume. Higher hospital volume was associated with shorter length of stay (P<.001). No association between hospital volume and either charges or risk of complications was observed. Conclusions: Higher surgeon and hospital volumes are associated with better outcome among infants who are treated for pyloric stenosis. Identification of aspects of medical and surgical treatment that account for this finding may lead to improvement in the outcome of infants undergoing pyloromyotomy.