Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy

Background The effects of hospital location and designation on postoperative pediatric outcomes remain unclear. We hypothesized that urban hospital outcomes would be superior to rural hospitals, and that outcomes at urban centers would differ for children from rural versus urban counties. Methods Retrospective cohort study of children undergoing appendectomy (n = 129,507) and pyloromyotomy (n = 13,452) using the 2006/2009 KID databases. Hospitals were characterized by specialty designation and classified as urban/rural. County of residence was classified as urban/rural. Outcomes included complications and length of stay. Multivariate regression models were used to adjust for confounding. Results Among appendectomy patients, treatment at urban hospitals was associated with reduced odds of any postoperative complication (OR = 0.77, 95% C.I. 0.70-0.85) and anesthesia-related complications (OR = 0.72, 95% C.I. 0.57-0.91). This association was strongest in the youngest children (<5 years) and at children's hospitals. For pyloromyotomy patients, urban hospitals were associated with reduced odds of any complication (OR = 0.43, 95% C.I. 0.24-0.75), anesthesia-related complications (OR = 0.14, 95% C.I. 0.05-0.37), and duodenal perforation (OR = 0.46, 95% C.I. 0.19-1.07). These associations were most significant at children's hospitals. Conclusions Postoperative outcomes appear to be improved at urban specialty hospitals relative to rural hospitals for certain common pediatric procedures. Identification of the factors driving this association may help inform resource optimization efforts in pediatric surgery.