P0996 - Volume-Outcome Relationship for Pectus Excavatum Repair in Children

Background: Pectus excavatum (PE) is the most common congenital chest wall deformity repaired in children. Hospital and surgeon volume vary significantly and may affect outcomes. We aimed to characterize the relationship of hospital and surgeon volume with the following outcomes: surgical complications (SCs) and length of stay (LOS).


Methods: PE repairs performed on patients 10-18 years old between 2013-2018 were identified using the Pediatric Health Information System (PHIS). SCs were identified using the PHIS SC flag. Hospitals and surgeons were stratified by quartile according to PE repair volume. Multivariable regression models, adjusting for patients’ age, sex, and race, were used to examine the relationship of volumes and outcomes.

Results: Over the study period, 4,799 patients (14.7 +/- 1.6 years old, 84% male, and 87% non-Hispanic white) underwent PE repair across 42 children’s hospitals. PE repair was performed by a total of 349 surgeons with 35 (10%) surgeons performing more than half (2,526, 52%) of all cases. The lowest volume hospitals had 4.5 times higher odds of SC (OR = 4.5, 95% CI 2.9-7.1, p<0.001) when compared to the highest quartile (hospital volume IQR = 59 – 140). The lowest volume surgeons had 3.0 times higher odds of SC (OR = 3.0, 95% CI 2.0-4.5, p<0.001) when compared to the highest quartile (surgeon volume IQR = 2 – 14). (Figure) LOS was significantly shorter at the highest volume hospitals compared to lowest volume centers by 13.7 hours (p=0.004), and for high volume surgeons compared to lowest volume surgeons by 14.6 hours (p<0.001).

Conclusion: Higher hospital and surgeon volume of PE repair are associated with lower odds of a SC and decreased LOS. These data further support that a volume-outcome relationship exists for PE repair in children. To mitigate SCs, efforts to identify optimal surgeon and hospital PE repair volumes are needed.