A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes

Shawn D. Safford, Ricardo Pietrobon, Kristine M. Safford, Henrique Martins, Michael A. Skinner, Henry E. Rice

Research output: Contribution to journalArticle

73 Scopus citations


Aim: The availability of large clinical databases allows for careful evaluation of surgical practices, indicators of quality improvement, and cost. We used a large clinical database to compare the effect of surgeon and hospital volume for the care of children with hypertrophic pyloric stenosis (HPS). Methods: Patients with International Classification of Diseases-9 codes for HPS and pyloromyotomy were selected from the 1994 to 2000 National Inpatient Samples database. Multiple and logistic regression models were used to evaluate the risk-adjusted association between provider volume and outcomes. Results: Postoperative complications occurred in 2.71% of patients. Patients operated on by low- and intermediate-volume surgeons were more likely to have complications compared with those operated on by high-volume surgeons (95% confidence interval [CI], 1.25-3.78 and 95% CI, 1.25-2.69, respectively). Patients operated at low-volume hospitals were 1.6 times more likely to have complications compared with those operated at intermediate- or high-volume hospitals (95% CI, 1.19-2.20). Procedures performed at high-volume hospitals were less expensive than those at intermediate-volume hospitals by a margin of $910 (95% CI, $443-$1377). Conclusions: These data represent the largest study to date on the epidemiology, complication rate, and cost for care for HPS. Patients treated by both high-volume surgeons and at high-volume hospitals have improved outcomes at less cost.

Original languageEnglish (US)
Pages (from-to)967-973
Number of pages7
JournalJournal of Pediatric Surgery
Issue number6
StatePublished - Jun 1 2005



  • Hypertrophic pyloric stenosis
  • Mucosal perforation
  • Pyloromyotomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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