Journal article
Decline of Pediatric Ambulatory Surgery Cases Performed at Florida General Hospitals Between 2010 and 2018: An Historical Cohort Study
Anesthesia and analgesia, Vol.131(5), pp.1557-1565
2020
DOI: 10.1213/ANE.0000000000004676
PMID: 32022746
Abstract
In the province of Ontario, nonphysiologically complex surgical procedures have increased at 4 pediatric hospitals with a reciprocal decline among the other (general) hospitals performing pediatric surgery. Given the differences between the Canadian and US health systems, we studied whether a similar shift occurred in the state of Florida and examined the age dependence of the shift. We used outpatient pediatric surgery data from all nonfederal hospitals, hospital-owned facilities, and independent ambulatory surgery centers in Florida, 2010-2018. Inferential analyses were performed comparing 2010-2011 with 2017-2018. Annual caseloads are reported as cases per workday by dividing by 250 workdays per year. Statewide, comparing 2010-2011 with 2017-2018, among children 1-17 years, pediatric hospitals' caseload increased overall by 50.7 cases per workday, overall meaning collectively among all hospitals combined. The caseload at general hospitals and ambulatory surgery centers, combined, decreased by 97.7 cases per workday. The general hospitals performed 54.7 fewer cases per workday. Among the 112 general hospitals, the mean pairwise decline was -0.49 cases per workday (99% confidence interval, -0.87 to -0.10; P < .0001). The changes were due to multiple categories of procedures, not just a few.Comparing 2010-2011 with 2017-2018, among 3 age cohorts (1-5, 6-12, and 13-17 years), the pediatric hospitals, statewide, performed overall 16.2, 15.1, and 19.3 more cases per workday, respectively. The general hospitals and ambulatory surgery centers, combined, performed fewer cases per workday for each cohort: 49.4, 21.4, and 26.9, respectively. The general hospitals overall performed fewer cases per workday for each cohort: 27.3, 12.1, and 15.4, respectively. Among general hospitals, the mean pairwise difference in the declines between patients 1-5 years vs 6-17 years was 0.00 cases per workday (99% confidence interval, -0.13 to +0.14). The decline across all age groups was inconsistent with multiple general hospitals increasing their minimum age threshold for surgical patients because, otherwise, the younger patients would have accounted for a larger share of the decreases in caseload. Pediatric hospitals and their anesthesiologists have greater surgical growth than expected from population demographics. Many general hospitals can expect either needing fewer pediatric anesthesiologists or that their pediatric anesthesiologists, who also care for adults, will have smaller proportions of pediatric patients in their practices.
Details
- Title: Subtitle
- Decline of Pediatric Ambulatory Surgery Cases Performed at Florida General Hospitals Between 2010 and 2018: An Historical Cohort Study
- Creators
- Franklin Dexter - From the Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IowaRichard H Epstein - Department of Anesthesiology, Pain Management, and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, FloridaLuis I Rodriguez - Department of Anesthesiology, Pain Management, and Perioperative Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Resource Type
- Journal article
- Publication Details
- Anesthesia and analgesia, Vol.131(5), pp.1557-1565
- Publisher
- International Anesthesia Research Society; United States
- DOI
- 10.1213/ANE.0000000000004676
- PMID
- 32022746
- ISSN
- 0003-2999
- eISSN
- 1526-7598
- Language
- English
- Date published
- 2020
- Academic Unit
- Health Management and Policy; Anesthesia
- Record Identifier
- 9983806281102771
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