Surgical Endoscopy

, Volume 32, Issue 5, pp 2201–2211 | Cite as

Hospital variation in rates of concurrent fundoplication during gastrostomy enteral access procedures

  • Anne M. Stey
  • Charles D. Vinocur
  • R. Lawrence Moss
  • Bruce L. Hall
  • Mark E. Cohen
  • Kari Kraemer
  • Clifford Y. Ko
  • Brian D. Kenney
  • Loren Berman
Article

Abstract

Background

This study aimed to determine whether (1) the propensity for concurrent fundoplication during gastrostomy varies among hospitals, and (2) postoperative morbidity differs among institutions performing fundoplication more or less frequently.

Methods

Children who underwent gastrostomy with or without concurrent fundoplication were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P). A hierarchical multivariate regression modeled the excess effects that hospitals exerted over propensity for concurrent fundoplication adjusting for preoperative clinical variables. Hospitals were designated as low outliers (significantly lower-adjusted odds of concurrent fundoplication than the average hospital with similar patient mix), average hospitals, and high outliers based on their risk-adjusted concurrent fundoplication practice. The postoperative morbidity rates were compared among low-outlier, average, and high-outlier hospitals.

Results

Between 2011 and 2013, 3775 children underwent gastrostomy at one of 54 ACS-NSQIP-P participating hospitals. The mean hospital concurrent fundoplication rate was 11.7% (range 0–64%). There was no significant difference in unadjusted morbidity rate in children with concurrent fundoplication, 11.0% compared to 9.7% in children without concurrent fundoplication. After controlling for clinical variables, 8 hospitals were identified as low outliers (fundoplication rate of 0.4%) and 16 hospitals were identified as high outliers (fundoplication rate of 34.6%). The average unadjusted morbidity rate among hospitals with low, average, and high odds of concurrent fundoplication were 9.6, 10.6, and 8.4%, respectively.

Conclusion

Hospitals vary significantly in propensity for concurrent fundoplication during gastrostomy yet postoperative morbidity does not differ significantly among institutions performing fundoplication more or less frequently.

Keywords

Fundoplication Pediatric surgery Hospital variation 

Abbreviations

ACS-NSQIP-P

American College of Surgeons’ National Surgical Quality Improvement Program Pediatric

ASA

American Society of Anesthesiologists

CPT

Current procedural terminology

Notes

Compliance with ethical standards

Disclosures

Anne Stey, Charles D. Vinocur, R. Lawrence Moss, Bruce L. Hall, Mark E. Cohen, Kari Kraemer, Clifford Y. Ko, Brian D. Kenney, and Loren Berman have no conflict of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anne M. Stey
    • 1
    • 2
  • Charles D. Vinocur
    • 3
  • R. Lawrence Moss
    • 4
  • Bruce L. Hall
    • 5
    • 6
    • 7
    • 8
  • Mark E. Cohen
    • 8
  • Kari Kraemer
    • 8
  • Clifford Y. Ko
    • 2
    • 8
  • Brian D. Kenney
    • 4
  • Loren Berman
    • 3
  1. 1.Icahn School of Medicine at Mount Sinai Medical CenterNew YorkUSA
  2. 2.David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  3. 3.Nemours/Alfred I. duPont Hospital for ChildrenJefferson Medical CollegeWilmingtonUSA
  4. 4.Nationwide Children’s HospitalThe Ohio State UniversityColumbusUSA
  5. 5.Department of Surgery, Olin Business School, and Center for Health PolicyWashington University School of Medicine in Saint LouisSt. LouisUSA
  6. 6.St Louis VA Medical CenterSt. LouisUSA
  7. 7.BJC Healthcare Saint LouisSt. LouisUSA
  8. 8.American College of SurgeonsChicagoUSA

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