High-volume hospitals experience fewer postoperative complications after neonatal surgery: Analyses of the National Clinical Database Pediatric Surgical Registry in Japan.

PURPOSE: Previous studies on volume-outcome relationships suggest pediatric surgical procedures could potentially improve their clinical outcomes. However, the evidence remains scarce. This study aimed to investigate the distribution and the hospital-level volume-outcome relationships for neonatal surgery in Japan.

METHODS

Data from the National Clinical Database Pediatric Surgical Registry, a nationwide pediatric surgical registry (2015-2020) was analyzed. Hospitals were categorized as low-volume (>0 to <10), middle-volume (≥10 to <36), and high-volume (≥36) based on the mean annual number of neonatal surgeries. The incidences of periprocedural outcomes of six major neonatal procedures (esophageal atresia, congenital diaphragmatic hernia, omphalocele, gastroschisis, intestinal atresia, and duodenal atresia) were compared among surgical volume groups. The outcomes included in-hospital death, any postoperative complications within 30 days (surgical [wound dehiscence, anastomotic leakage, reoperation, and readmission] or otherwise), and operative time. We assessed the hospital volume-outcome relationship adjusting for surgery type, gestational age, preoperative cardiac risk, chromosomal abnormality, and 5-min-Apgar score.

RESULTS

Of the 738 hospitals, 154, 76, and 12 were categorized as low-, middle-, and high-volume hospitals, respectively, while 496 performed no neonatal surgeries. The incidence of any postoperative complications was lower at high-volume (252/1075 [23.5 %]; reference) than at low-volume (230/770 [29.9 %], adjusted odds ratio 1.46, 95 % confidence interval: 1.16-1.83) and middle-volume (622/2219 [28.0 %], 1.31, 1.09-1.58) hospitals.

CONCLUSIONS

The incidence of postoperative complications was lower in high-volume hospitals. Centralizing neonatal surgical facilities may improve pediatric surgery outcomes in Japan.