SCH fracture is the second most common fracture in children and the pediatric fracture most commonly requiring operative intervention.
17 Pediatric supracondylar humerus (SCH) fractures are an example. The most appropriate targets for reducing variation are high-volume conditions, which may, therefore, have considerable clinical and financial impact. 12 Importantly, physicians have demonstrated an interest in standardization and a willingness to change practice when guidelines are available. 3 This void creates an opportunity for research and creation of clinical decision-making guidelines. 3, 5, 7– 11 Variation in decision-making tends to surround topics for which there is relative uncertainty and no clinical guidelines. Decision-making by individual providers has frequently been highlighted as a source of variation. 6 Identification is the first step in the process of reducing excess variation. 2 Decreasing variability in healthcare can improve quality of care, decrease cost, and improve value. 1– 5 While variability is normal, it can also negatively impact individual patient care and the healthcare system by eroding quality and adding to cost unnecessarily. Variability exists in many forms throughout healthcare.
Cost of care was also significantly lower at high-volume centers (p<0.001).Ĭonclusions: At hospitals with low surgical volumes, children with SCH fractures are more likely to undergo ORPP and have a significantly higher cost of care. There was no difference in ORPP rates based on the USNWR ranking. Patients treated at high-volume centers were less likely to undergo ORPP than patients at lower-volume centers (5.1% vs. Analysis demonstrated significant variation in cost and ORPP rates between hospitals (p<0.001). Adjusted for patient characteristics, ORPP rates ranged from 4.2%–15.0%. Unadjusted ORPP rates varied from 1.9%-12.8%. Results: 28,100 patients were treated at 42 pediatric hospitals. Analysis then assayed the effect of hospital treatment and ranking on cost of care and likelihood to treat with ORPP. To account for differences in patient population, hospital ORPP rates were adjusted for patient characteristics. Pediatric orthopaedic hospital rankings were collected from U.S. children’s hospitals, was queried for patients 3-10 years treated with ORPP or CRPP for closed SCH fractures from 2010-2014. Methods: The Pediatric Health Information System (PHIS), a database of U.S. Secondarily, we investigated costs associated with ORPP and closed reduction and percutaneous pinning (CRPP). children’s hospitals by hospital treatment volume and ranking. This investigation sought to assess variation in ORPP rates among U.S. Received: FebruAccepted: NovemPublished: February 1, 2023īackground: Open reduction and percutaneous pinning (ORPP) of pediatric supracondylar humerus (SCH) fractures is associated with increased morbidity compared to closed reduction. Shah, MD, MBA, Children’s Hospital of Philadelphia, 34 th and Civic Center Blvd., Wood Building, 2 nd floor, Philadelphia, PA 19104. Shah, MD, MBA 2ġHarvard Combined Orthopaedic Residency Program, Boston, MA 2Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PAĬorrespondence: Apurva S. Striano, MD 1 Divya Talwar, PhD, MPH 2 John M. High-Volume Hospitals Have Lower Open Reduction Rates and Lower Cost of Care for Pediatric Supracondylar Humerus Fracturesīrendan M.
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