Hospital-Level Factors Associated with Nonoperative Management in Common Pediatric Surgical Procedures

Abstract 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 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 over 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