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Jurnal Internasional Kep Ank
Jurnal Internasional Kep Ank
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A R T I C L E I N F O A B S T R A C T
Article history:
BACKGROUND: The impact of surgical volume on outcomes in Hirschsprung’s disease (HD)
Received 18 February 2020
remains uninvestigated. We aimed to determine whether higher surgeon and hospital-
Received in revised form
level HD operative volumes are associated with improved surgical outcomes following
14 July 2020
primary surgery for neonatal HD.
Accepted 2 August 2020
MATERIALS AND methods: Neonates who underwent either an ostomy or pull-through (PT)
Available online xxx
procedure for HD before 60 d of life and a PT procedure by age 1 y were identified in
the Pediatric Health Information System (PHIS). Index admissions from January
Keywords:
2000 to September 2012 across 41 tertiary childrens hospitals were included. Surgeon and
Enterocolitis
hospital- level HD operative volume were defined as the average annual number of PT
Hirschsprung’s disease
procedures performed for HD in the 2 y preceding each included case. We examined the
Pediatric surgery
relationship between operative volumes and all-cause readmission, readmission for
Neonatology
Hirschsprung’s associated enterocolitis (HAEC), and rates of reoperation within 30 d and
Pull-through procedure
2 y.
Volume-outcome
Results: A total of 1268 infants were included. There were 218 patients (17.2%)
readmitted to the hospital within 30 d and 540 (42.6%) within 2 y. A total of 119 patients
(9.4%) had HAEC- related readmission within 30 d, and 271 (21.4%) had HAEC-related
readmission within 2 y. A total of 57 patients (4.5%) had a reoperation within 30 d and 129
(10.2%) within 2 y. In risk- adjusted analyses, there were no significant associations
between either surgeon or hos- pital HD operative volumes and readmission/reoperation
rates within 30 d or 2 y.
Conclusions: Neither surgeon nor hospital PT volumes were significantly associated
with readmission or reoperation rates for infants with Hirschsprung’s disease. Future
work is needed to evaluate whether operative volumes are associated with functional
outcomes following PT for HD.
ª 2020 Elsevier Inc. All rights reserved.
* Corresponding AUTHOR. Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at
Nationwide Childrens Hospital, 700 Children’s Drive, FB Suite 3A.3, Columbus, OH, 43205. Tel.: þ1614 355-4526; fax: þ1614 722-3544.
E-mail address: jennifer.cooper@nationwidechildrens.org (J.N. Cooper).
0022-4804/$ e see front matter ª 2020 Elsevier Inc. All rights
reserved. https://doi.org/10.1016/j.jss.2020.08.014
380 R C h ● J A NUARY 2 0 2 1 ( 2 5 7 ) 3 7 9 e3 8 8
N = 840
No pull through procedure by age 1 yea
N = 2481
N = 277
N = 2204 No ostomy or pull through procedure by age 6
N = 41
Pull through or total colectomy AND ostomy procedure on firs
N = 2163
N = 23
Data quality issues (incorrect dates of service or dup
N = 2140
N = 60
Operated on by a surgeon without a surgeo
N = 2080
N = 812
Operated on by a surgeon who did not have evidence of having performed surgeries at the patient’s hospital during
N = 1268
Probability
Probability 0.7 0.7
0.6 0.6
0.5 0.5
0.4 0.4
readmission within
readmission within
0.3 0.3
0.2 0.2
0.1 0.1
0 0
0 5 10 15 20 05101520253035
Surgeon volume Hospital volume
2 years of all-cause
2 years of all-cause
C 1
0.9
D 1
0.9
0.8 0.8
Probability
Probability
0.7 0.7
0.6 0.6
0.5 0.5
0.4 0.4
readmission within
readmission within
0.3 0.3
0.2 0.2
0.1 0.1
0 0
0 5 10 15 20 05101520253035
Surgeon volume Hospital volume
Fig. 2 e Relationship between the surgeon and hospital pull-through volumes and all-cause readmission with 30 d and 2 y,
respectively, for infants with Hirschsprungs disease.
30 daysof HAEC-related
30 daysof HAEC-related
A 1
0.9
B 1
0.9
0.8 0.8
0.7 0.7
0.6 0.6
Probability
0.5 0.5
Probability
0.4 0.4
0.3 0.3
0.2 0.2
readmission within
readmission within
0.1 0.1
0 0
0 5 10 15 20 05101520253035
2 yearsof HAEC-related
2 yearsof HAEC-related
C 1
0.9
D 1
0.9
0.8 0.8
0.7 0.7
Probability
Probability
0.6 0.6
0.5 0.5
0.4 0.4
readmission within
readmission within
0.3 0.3
0.2 0.2
0.1 0.1
0 0
0 5 10 15 20 05101520253035
Surgeon volume Hospital volume
Fig. 3 e Relationship between the surgeon and hospital pull-through volumes and HAEC-related readmission with 30 d and
2 y, respectively, for infants with Hirschsprungs disease.
A 1 B 1
0.9 0.9
0.8 0.8
within 2 yearsProbability of reoperation within 30 days Probability of reoperation
0 5 10 15 20 05101520253035
Surgeon volume Hospital volume
C 1
0.9 D 1
0.9
0.8 0.8
0 5 10 15 20 05101520253035
Surgeon volume Hospital volume
Fig. 4 e Relationship between the surgeon and hospital pull-through volumes and reoperation with 30 d and 2 y,
respectively, for infants with Hirschsprungs disease.
P ¼ 0.76*
2-year reoperation
P ¼ 0.99y
studies on complex birth defects have demonstrated a
volume- outcome relationship, underscoring the
persistent need to identify, measure, and track
competencies in managing complex surgical
anomalies.35,36,40,59-61
These findings are consistent with those of another recent
10.0
12.0
10.8
12.8
study utilizing the PHIS, which assessed risk factors for recur-
rent HAEC-related admissions and repeated pull-through
30-day reoperation
P ¼ 0.76*
P ¼ 0.99y
6.4
4.9
4.8
P ¼ 0.24*
P ¼ 0.65y
26.0
18.0
19.5
P ¼ 0.19*
P ¼ 0.52y
10.4
8.7
14.3
P ¼ 0.44*
P ¼ 0.32y
48.7
42.4
42.5
P ¼ 0.18*
20.1
14.0
21.6
66.