Postnatal repair for myelomeningocele (MMC) is a time-sensitive and technically challenging procedure. More experienced hospitals may provide improved outcomes for the complexity of care associated with these patients. No prior study has investigated the impact of MMC treatment at pediatric hospitals. The authors sought to examine the effect of pediatric hospital designation on patients undergoing postnatal MMC repair to identify factors associated with maximizing improved patient outcomes.
开云体育世界杯赔率
The Nationwide Readmissions Database records from 2010 to 2018 were analyzed retrospectively to determine the effect of hospital designation on patient outcomes after postnatal MMC repair. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if MMC repair at a designated pediatric hospital was independently associated with patient outcomes of perinatal infection rates, discharge disposition, and length of stay.
RESULTS
总数的6353 underw儿科患者ent postnatal MMC repair between 2010 and 2018, 2224 (35.0%) received care at a pediatric hospital. Those with an extreme level of disease burden as defined by the all patient refined diagnosis-related group severity of illness index were more likely to be treated at a pediatric hospital (p = 0.03). Patients undergoing repair at a pediatric hospital were also associated with a decreased likelihood of perinatal infection (OR 0.54, 95% CI 0.35–0.83, p = 0.005); greater likelihood of routine disposition (OR 4.85, 95% CI 2.34–10.06, p < 0.0001); and shorter length of stay (incidence rate ratio 0.88, 95% CI 0.77–0.995, p = 0.04).
CONCLUSIONS
Pediatric patients requiring intervention for postnatal repair of MMC may benefit from the multidisciplinary subspeciality care offered at pediatric hospitals. The authors found that postnatal repair of MMC at pediatric hospitals was associated with a greater likelihood of improved patient outcomes.
ABBREVIATIONS
APR-DRG = all patient refined diagnosis-related group;CCC = complex chronic conditions;ICD-9 = International Classification of Diseases, Ninth Edition;ICD-10 = International Classification of Diseases, Tenth Edition;IRR = incidence rate ratio;LOS = length of stay;MCM = multidisciplinary care model;MMC = myelomeningocele;NRD = Nationwide Readmissions Database.
CorrespondenceJane S. Han: University of Southern California, Keck School of Medicine, Los Angeles, CA.hansungm@usc.edu.
INCLUDE WHEN CITINGPublished online June 16, 2023; DOI: 10.3171/2023.5.PEDS22564.
DisclosuresDr. Mack reported the following: consultant for Rebound Therapeutics, Viseon Imperative Care, Integra, Q’Apel, Medtronic, Stream Biomedical, Spartan Micro, and Egret. He is also an investor in Cerebrotech, Q’Apel, Endostream, Viseon Imperative Care, Rebound Therapeutics, Stream Biomedical, Truvic, Spartan Micro, Radical Catheters, Vastrax, and Borvo.
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