Influence of surgical volume on the mortality and morbidity of gastrointestinal perforation in children.

Purpose: To clarify the influence of surgical volume on the mortality and morbidity of gastrointestinal perforation in children in Japan. Methods: We collected data on pediatric patients with gastrointestinal perforation between 2017 and 2019, from the National Clinical Database. The surgical volumes of various institutions were classified into three groups: low (average number of surgeries for gastrointestinal perforation/year < 1), medium (≥ 1, < 6), and high (≥ 6). The observed-to-expected (o/e) ratios of 30-day mortality and morbidity were calculated for each group using an existing risk model. Results: Among 1641 patients (median age, 0.0 years), the 30-day mortality and morbidity rates were 5.2% and 37.7%, respectively. The 30-day mortality rates in the low-, medium-, and high-volume institutions were 4.9%, 5.3%, and 5.1% (p = 0.94), and the 30-day morbidity rates in the three groups were 26.8%, 39.7%, and 37.7% (p < 0.01), respectively. The o/e ratios of 30-day mortality were 1.05 (95% confidence interval [CI] 0.83–1.26), 1.08 (95% CI 1.01–1.15), and 1.02 (95% CI 0.91–1.13), and those of 30-day morbidity were 1.72 (95% CI 0.93–2.51), 1.03 (95% CI 0.79–1.28), and 0.95 (95% CI 0.56–1.33), respectively. Conclusion: Surgical volume does not have significant impact on the outcomes of pediatric gastrointestinal perforation in Japan. [ABSTRACT FROM AUTHOR]