Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis Journal Article

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Authors: Cobb, A. N.; Wong, Y. M.; Brownlee, S. A.; Blanco, B. A.; Ezure, Y.; Paddock, H. N.; Kuo, P. C.; Kothari, A. N.
Article Title: Perioperative support, not volume, is necessary to optimize outcomes in surgical management of necrotizing enterocolitis
Abstract: BACKGROUND: This study examines the relationship between hospital volume of surgical cases for necrotizing enterocolitis (NEC) and patient outcomes. METHODS: A retrospective cross-sectional review was performed using the HCUP SID for California from 2007 to 2011. Patients with NEC who underwent surgery were identified using ICD-9CM codes. Risk-adjusted models were constructed with mixed-effects logistic regression using patient and demographic covariates. RESULTS: 23 hospitals with 618 patients undergoing NEC-related surgical intervention were included. Overall mortality rate was 22.5%. There were no significant differences in the number of NICU beds (p = 0.135) or NICU intensivists (p = 0.469) between high and low volume hospitals. Following risk adjustment, no difference in mortality rate was observed between high and low volume hospitals respectively (24.0% vs. 20.3%, p = 0.555). CONCLUSIONS: Our observation that neonates with NEC treated at low-volume centers have no increased risk of mortality may be explained by similar availability of NICU and intensivists resources across hospitals.
Journal Title: American Journal of Surgery
Volume: 213
Issue: 3
ISSN: 1879-1883; 0002-9610
Publisher: Elsevier Inc  
Journal Place: United States
Date Published: 2017
Start Page: 502
End Page: 506
Language: eng
DOI/URL:

S0002-9610(16)30828-5
Notes: LR: 20170417; CI: Copyright (c) 2016; GR: T32 GM008750/GM/NIGMS NIH HHS/United States; JID: 0370473; NIHMS831139; OTO: NOTNLM; PMCR: 2018/03/01; 2016/07/26 [received]; 2016/11/04 [revised]; 2016/11/07 [accepted]; ppublish