ArticleHealth services research2019
Impact of pediatric cardiac surgery regionalization on health care utilization and mortality.
Article in Health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- An updated systematic review of the impact of volume of surgery and specialization in Norwood procedure.BMC pediatrics · 2026Pooled it
- Impact of social factors on outcomes following pediatric neuro-oncology surgery in the United States: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Geospatial Access to Pediatric Cardiac and Cardiac-Surgical Services by Neighborhood-Level Determinants of Health.Journal of the American Heart Association · 2026Article
- Development of an Atlas for US Pediatric Acute Care.JAMA pediatrics · 2026Article
- Center Volume and Failure to Rescue in Pediatric Cardiac Surgery: Is There a Relationship?The Annals of thoracic surgery · 2026Article
- Article
- Direct medical costs of congenital heart surgery for isolated lesions in Rwanda.PLOS global public health · 2025Article
- Racial Health Disparity Associated With Poor Pediatric Cardiac Surgery Outcomes: A Multicentered, Cross-Sectional Study.JACC. Advances · 2024Article
- Improved postoperative outcomes in pediatric major surgery: evidence from hospital volume analysis.European journal of pediatrics · 2024Article
- Do Unpaid Children's Hospital Account Balances Correlate with Family Income or Insurance Type?Plastic and reconstructive surgery. Global open · 2023Article
- Procedure-Specific Center Volume and Mortality After Infantile Congenital Heart Surgery.The Annals of thoracic surgery · 2023Article
- Volume creates value: The volume-outcome relationship in Scandinavian obesity surgery.Health services management research · 2022Article
- Reimagining and reinvesting in rural hospital markets.Health services research · 2022Article
- How did we get here? Thoughts on health care system drivers of pediatric radiology burnout.Pediatric radiology · 2022Article
- Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation.JAMA network open · 2021Article
- The Risks of Being Tiny: The Added Risk of Low Weight for Neonates Undergoing Congenital Heart Surgery.Pediatric cardiology · 2020Article
- An Overview of Contemporary Outcomes in Fetal Cardiac Intervention: A Case for High-Volume Superspecialization?Pediatric cardiology · 2020Review
- Impact of pediatric cardiac surgery regionalization on health care utilization and mortality.Health services research · 2019Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveRegionalization directs patients to high-volume hospitals for specialized care. We investigated regionalization trends and outcomes in pediatric cardiac surgery. DATA SOURCES/STUDY
settingStatewide inpatient data from eleven states between 2000 and 2012. STUDY
designMortality, length of stay (LOS), and cost were assessed using multivariable hierarchical regression with state and year fixed effects. Primary predictor was hospital case-volume, categorized into low-, medium-, and high-volume tertiles. DATA COLLECTION/EXTRACTION
methodsWe used Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) to select pediatric cardiac surgery discharges. PRINCIPAL
findingsIn total, 2841 (8.5 percent), 8348 (25.1 percent), and 22 099 (66.4 percent) patients underwent heart surgeries in low-, medium-, and high-volume hospitals. Mortality decreased over time, but remained higher in low- and medium-volume hospitals. High-volume hospitals had lower odds of mortality and cost than low-volume hospitals (odds ratio [OR] 0.59, P < 0.01, and relative risk [RR] 0.91, P < 0.01, respectively). LOS was longer for high- and medium-volume hospitals, compared to low-volume hospitals (high-volume: RR 1.18, P < 0.01; medium-volume: RR 1.05, P < 0.01).
conclusionsRegionalization reduced mortality and cost, indicating fewer complications, but paradoxically increased LOS. Further research is needed to explore the full impact on health care utilization.
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