Hospital-level factors associated with nonoperative management in common pediatric surgical procedures

Purpose: Our purpose was to examine patient- and hospital-level factors associated with nonoperative management in common pediatric surgical diagnoses. Methods: Using the 2012 Kid's Inpatient Database (KID), we identified patients < 20 years old diagnosed with cholecystitis (CHOL), bowel obstruction (BO), perforated appendicitis (PA), or spontaneous pneumothorax (SPTX). Logistic regression models were used to identify factors associated with nonoperative management. Results: Of 36,026 admissions for the diagnoses of interest, 7472 (20.7%) were managed nonoperatively. SPTX had the highest incidence of NONOP (55.9%; n = 394), while PA had the lowest incidence (9.2%; n = 1641). Utilization of operative management varied significantly between hospitals. Patients diagnosed with BO (OR 0.41; 95% CI 0.30–0.56) and SPTX (OR 0.28; 95% CI 0.14–0.56) had decreased odds of operative management when treated at an urban, teaching hospital compared to a rural hospital. Patients with PA had increased odds of operative management when treated at an urban, teaching hospital (OR 2.42; 95% CI 1.78–3.30). Hospital-level factors associated with decreased odds of nonoperative management included urban, nonteaching status (OR 0.54; 95% CI 0.31–0.91) and location in the South (OR 0.53; 95% CI 0.34–83) and West (OR 0.47; 95% CI 0.30–0.74). Conclusions: Despite representing more than 20% of pediatric surgical care for several conditions, nonoperative management is an understudied aspect of care with significant variation that warrants further research. Level of evidence: III