Characteristics and Outcomes of Infants in Texas by Facility Children's Surgery Verification Status

J Surg Res. 2024 Oct:302:784-789. doi: 10.1016/j.jss.2024.07.115. Epub 2024 Sep 1.

Abstract

Introduction: The American College of Surgeons Children's Surgery Verification (CSV) status recognizes hospitals that deliver high-quality pediatric surgical care. Texas has 5 CSV centers in three cities, which may limit equitable access to care. We explored the characteristics and outcomes of infants admitted in Texas as a function of facility CSV status.

Materials and methods: We retrospectively reviewed a state-wide hospital discharge database (2013-2021). All patients <1 y of age were included. Patients transferred to an outside hospital were excluded to avoid double counting. Descriptive statistics and chi-square analysis were performed.

Results: We analyzed 3,617,173 admissions, with 211,278 (6%) treated at CSV centers. CSV admissions were less likely to be inborn (46% versus 93%) and more likely to be transfers (16% versus 1%). CSV centers also had sicker patients (32% versus 13% extreme illness severity) with higher mortality rates (1% versus 0%), longer length of stay (9 ± 22 versus 4 ± 9), and higher operative rates (33% versus 20%). However, mortality was lower at CSV centers when matched for illness severity. Proportionately more patients from rural counties (9% versus 4%) and counties along the United States-Mexico border (13% versus 1%), as well as patients of Hispanic ethnicity (39% versus 33%), were treated at non-CSV centers. Meanwhile, proportionately more African Americans (21% versus 11%) were treated at CSV centers.

Conclusions: CSV centers are associated with improved outcomes among patients with high illness severity. Population differences among patients treated at CSV centers compared to non-CSV centers may represent disparities in access to care and warrant further evaluation.

Keywords: Children's surgery verification; Disparities; Infants; Outcomes; Texas.

MeSH terms

  • Female
  • Health Services Accessibility / statistics & numerical data
  • Healthcare Disparities / statistics & numerical data
  • Hospital Mortality
  • Hospitals, Pediatric* / organization & administration
  • Hospitals, Pediatric* / standards
  • Hospitals, Pediatric* / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Male
  • Retrospective Studies
  • Surgical Procedures, Operative / mortality
  • Surgical Procedures, Operative / statistics & numerical data
  • Texas / epidemiology