High-Volume Hospitals Have Lower Open Reduction Rates and Lower Cost of Care for Pediatric Supracondylar Humerus Fractures Original Research

Abstract

Background: Open reduction and percutaneous pinning (ORPP) of pediatric supracondylar humerus (SCH) fractures is associated with increased morbidity. This investigation sought to assess variation in ORPP rates among US children’s hospitals by hospital treatment volume and ranking. Secondarily, we investigated costs associated with ORPP and closed reduction and percutaneous pinning (CRPP).

Methods: The Pediatric Health Information System (PHIS), a database of US children’s hospitals, was queried for patients 3-10 years treated with ORPP or CRPP for closed SCH fractures from 2010-2014. Pediatric orthopaedic hospital rankings were collected from US News and World Report. To account for differences in patient population, hospital ORPP rates were adjusted for patient characteristics. Analysis then assayed the effect of hospital treatment and ranking on cost of care and likelihood to treat with ORPP.

Results: 28,100 patients were treated at 42 pediatric hospitals.  26,465 (94.2%) SCH fractures underwent CRPP and 1,635 (5.8%) underwent ORPP.  Unadjusted ORPP rates varied from 1.9%-12.8%. Adjusted for patient characteristics, ORPP rates ranged from 4.2%–15.0%. Analysis demonstrated significant variation in cost and ORPP rates between hospitals (p<0.001). Patients treated at high-volume centers were less likely to undergo ORPP than patients at lower-volume centers (5.1% vs. 6.7%; Odds Ratio 0.70, 95%CI: 0.54-0.90). There was no difference in ORPP rates based on the USNWR ranking. Cost of care was also significantly lower at high-volume centers (p<0.001).

Conclusions: At hospitals with low surgical volumes, children with SCH fractures are more likely to undergo ORPP and have significantly higher cost of care.