Relationship Between Hospital Surgical Volumes and Length of Stay for Index Conditions in Pediatric Surgery: A Canadian Population-Based Study

Abstract

Literature to on the volume-outcome relationship in pediatric surgery is inconclusive. This retrospective cohort study analyzed data from the Canadian Institute for Health Information from April 2010 to March 2023, to measure the association between hospital volume and length of stay (LOS) for infants treated for Hirschsprung’s disease (HD), esophageal atresia (EA) with tracheoesophageal fistula (TEF), or bladder exstrophy (BE). Restricted cubic splines modelled the nonlinear association between volume and binary patient outcomes. Eighteen Canadian hospitals were found to provide pediatric surgery. No significant association was detected between volume and LOS for patients treated for HD (n=563) or BE (n=37). The association was significant [IRR 1.04, p-value = 0.013] for patients with EA/TEF (n=278). Spline models demonstrated the relationship between volume and selected outcomes were non-linear. Results suggest that volume-outcome relationships are not generalizable across pediatric surgeries and differ from those reported in the adult literature.