Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients

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  • 1 Office of Human Research, Memorial Healthcare System, Hollywood;
  • 2 Florida Atlantic University, College of Medicine, Boca Raton;
  • 3 Divisions of Pediatric Surgery and
  • 5 Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, Hollywood; and
  • 4 Department of Neurological Surgery, University of Miami, Florida
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OBJECTIVE

In the pediatric population, few studies have examined outcomes for neurosurgical accidental trauma care based on hospital characteristics. The purpose of this study was to explore the relationship between hospital ownership type and children's hospital designation with primary outcomes.

METHODS

This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2006, 2009, and 2012 Kids’ Inpatient Database. Primary outcomes, including inpatient mortality, length of stay (LOS), and favorable discharge disposition, were assessed for all pediatric neurosurgery patients who underwent a neurosurgical procedure and were discharged with a primary diagnosis of accidental traumatic brain injury.

RESULTS

Private, not-for-profit hospitals (OR 2.08, p = 0.034) and freestanding children's hospitals (OR 2.88, p = 0.004) were predictors of favorable discharge disposition. Private, not-for-profit hospitals were also associated with reduced inpatient mortality (OR 0.34, p = 0.005). A children's unit in a general hospital was associated with a reduction in hospital LOS by almost 2 days (p = 0.004).

CONCLUSIONS

Management at freestanding children's hospitals correlated with more favorable discharge dispositions for pediatric patients with accidental trauma who underwent neurosurgical procedures. Management within a children's unit in a general hospital was also associated with reduced LOS. By hospital ownership type, private, not-for-profit hospitals were associated with decreased inpatient mortality and more favorable discharge dispositions.

ABBREVIATIONS APR-DRG = All Patients Refined Diagnosis Related Groups; CHA = Children's Hospital Association; HCUP = Healthcare Cost and Utilization Project; KID = Kids' Inpatient Database; LOS = length of stay; NACHRI = National Association of Children's Hospitals and Related Institutions; PNFP = private, not-for-profit; TBI = traumatic brain injury.

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Contributor Notes

Correspondence Heather Spader: Department of Neurosurgery, University of New Mexico, Albuquerque, NM. hspader@salud.unm.edu.

INCLUDE WHEN CITING Published online April 2, 2021; DOI: 10.3171/2020.10.PEDS20538.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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