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Experience-Related Data Limited in Children's Surgery

Wide variation seen in studies on methodology, outcomes, exposure definitions

THURSDAY, March 28 (HealthDay News) -- In pediatric surgery, hospital-level characteristics are often strongly associated with improved outcomes in rarer, more complex procedures, while surgeon-level factors may be more important predictors in common procedures, according to a review published online March 25 in JAMA Pediatrics.

Jarod P. McAteer, M.D., from Seattle Children's Hospital, and colleagues conducted a literature review for studies that measured hospital or surgeon experience as a predictor variable and postoperative outcomes as dependent response variables.

After reviewing 63 studies, the researchers found that there was significant heterogeneity in exposure definitions, outcome measures, and risk adjustment. The greatest heterogeneity was seen in appendectomy studies. Various exposure levels were assessed, including hospital level in 48 studies (68 percent), surgeon level in 11 (17 percent), and both in nine (14 percent). Among the limitations of the studies were that 19 percent of studies did not adjust for confounding and 57 percent did not adjust for sample clustering. Pediatric cardiac surgical literature had the most consistent methods and reproducible results. There was a positive correlation between experience and most primary outcomes in 78 percent of studies (49), but comparisons between studies was difficult because of differences in outcomes and exposure definitions. Generally, there was a correlation between hospital-level and outcomes for high-complexity procedures, while surgeon-level factors tended to correlate with outcomes for more common procedures.

"Data on experience-related outcomes in children's surgery are limited in number and vary widely in methodologic quality," the authors write.

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