• Daniel Rhee, Dominic Papandria, Jessica Yang, Yiyi Zhang, Gezzer Ortega, Paul M Colombani, David C Chang, and Fizan Abdullah.
• Department of Surgery, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
• J. Pediatr. Surg. 2013 Aug 1; 48 (8): 1657-63.

IntroductionImproved surgical outcomes in children have been associated with pediatric surgical specialization, previously defined by surgeon operative volume or fellowship training. The present study evaluates pediatric surgical outcomes through classifying surgeons by degrees of pediatric versus adult operative experience.MethodsA cross-sectional study was performed using nationally representative hospital discharge data from 1998 to 2007. Patients under 18 years of age undergoing inpatient operations in neurosurgery, otolaryngology, cardiothoracic, general surgery, orthopedic surgery, and urology were included. An index was created, calculating the proportion of children treated by each surgeon. In-hospital mortality and length of stay were compared by index quartiles. Multivariate analysis was adjusted for patient and hospital characteristics.ResultsA total of 119,164 patients were operated on by 13,141 surgeons. Within cardiothoracic surgery, there were 1.78 (p=0.02) and 2.61 (p<0.01) increased odds of mortality comparing surgeons in the lowest two quartiles for pediatric specialization respectively with the highest quartile. For general surgery, a 2.15 (p=0.04) increase in odds for mortality was found when comparing surgeons between the lowest and the highest quartiles. Comparing the least to the most specialized surgeons, length of stay increased 1.14 days (p=0.02) for cardiothoracic surgery, 0.58 days (p=0.04) for neurosurgery, 0.23 days (p=0.02) for otolaryngology, and decreased by 1.06 days (p<0.01) for orthopedic surgery.ConclusionThe present study demonstrates that surgeons caring preferentially for children-as a proportion of their overall practice-generally have improved mortality outcomes in general and cardiothoracic surgery. These data suggest a benefit associated with increased referral of children to pediatric practitioners, but further study is required.Copyright © 2013 Elsevier Inc. All rights reserved.

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