Date of Award

2021

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Annie N. Simpson

Second Advisor

Kit N. Simpson

Third Advisor

Elinor C. G. Borgert

Abstract

Children with anorectal malformations often receive a temporary colostomy or ileostomy before surgical repair of the anomaly to divert stool and allow their anatomy time to heal. Once their bodies have healed, the stoma is taken down, a standard procedure for pediatric general surgeons. However, for decades, stoma takedown surgery has been associated with a high risk of postoperative complications. This study seeks to determine if hospital prior-year stoma closure case volume influences pediatric patients' quality outcome measures. Population. This study identified 340 pediatric patients having undergone stoma closure surgery during the study period at hospitals in a representative sample of seven states; Arkansas, Florida, Georgia, Maryland, Mississippi, New York, and Washington. Study Design. This study is a retrospective analysis of archival billing data for pediatric stoma closure patients. The billing data source is the 2016 - 2017 Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) database. Outcome Measures. This study uses generally accepted surrogate measures of a quality outcome. The quality outcome measures for this study are the rate of in-hospital mortality during the index admission, readmission to the hospital within 30 days of discharge, and length of stay (LOS) during the index admission. Results. One mortality occurred in the study population (.29%), while 39 patients were readmitted (11.5%). Logistic regression analysis found no significant volume-outcome association between volume and the outcome measures. However, when categorized into age groups, a statistically significant association exists between hospital prior-year volume and readmission (p < .04) in the infant age group (Age < 1). A similar association was found between hospital prior-year volume and LOS (p < .002) in the infant group compared to the non-infant group. With each prior-year increase of 10 cases, the likelihood of readmission decreases by 52% and expected hospitalization days decreases by 25%. Conclusion. This study validates an inverse hospital volume-readmission association in infant stoma closure surgery and an inverse volume-LOS association among all pediatric patients, with the magnitude of the association being most significant in the infant population.

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