INTRODUCTION A large proportion of postoperative mortality after pediatric surgery occurs among neonates with specific high-risk diagnoses. The extent to which there is hospital-level mortality variation among patients with these diagnoses and whether this variation is associated with differences in failure to rescue (FTR) is unclear. METHODS The Pediatric Health Information System® database (2012-2020) was used to identify patients who underwent surgery for eight high-risk neonatal diagnoses: gastroschisis; volvulus; necrotizing enterocolitis; intestinal atresia; meconium peritonitis; tracheoesophageal fistula; congenital diaphragmatic hernia; and perinatal intestinal perforation. Hospitals were stratified into tertiles of reliability-adjusted inpatient mortality rates (lower than average mortality - tertile 1 [T1]; higher than average mortality - tertile 3 [T3]). Multivariable hierarchical regression was used to evaluate the association between hospital-level, reliability-adjusted mortality and FTR. RESULTS Overall, 20,838 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 4.0% (95% CI, 0.0-8.2) to 16.3% (12.2-20.4). Median case volume (range, 80-1,238) and number of NICU beds (range, 24-126) were not significantly different across hospital tertiles. Compared to the hospitals with the lowest postoperative mortality (T1), the odds of FTR were significantly higher in hospitals with the highest (T3) postoperative mortality (odds ratio 1.97 [1.50-2.59]). CONCLUSIONS Significant variation in neonatal hospital mortality for high-risk diagnoses does not appear to be explained by hospital structural characteristics. Rather, difference in FTR suggests quality improvement interventions targeting early recognition and management of postoperative complications could improve surgical quality and safety for high-risk neonatal care.

中文翻译：

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高危新生儿诊断手术后死亡率和抢救失败的医院差异。

简介 小儿手术后很大一部分术后死亡率发生在具有特定高风险诊断的新生儿中。这些诊断患者的医院死亡率差异程度以及这种差异是否与抢救失败 (FTR) 差异相关尚不清楚。方法 使用儿科健康信息系统®数据库（2012-2020）来识别因八种高危新生儿诊断而接受手术的患者：腹裂；肠扭转；坏死性小肠结肠炎; 肠闭锁；胎便性腹膜炎; 气管食管瘘；先天性膈疝；和围产期肠穿孔。将医院按照可靠性调整后的住院患者死亡率分为三分位数（低于平均死亡率 - 三分位数 1 [T1]；高于平均死亡率 - 三分位数 3 [T3]）。多变量层次回归用于评估医院级别、可靠性调整死亡率与 FTR 之间的关联。结果 总体而言，48 家学术儿科医院共识别出 20,838 名婴儿。调整后的医院死亡率范围为 4.0%（95% CI，0.0-8.2）至 16.3%（12.2-20.4）。不同医院三分位数的中位病例数（范围为 80-1,238）和 NICU 床位数量（范围为 24-126）没有显着差异。与术后死亡率最低（T1）的医院相比，术后死亡率最高（T3）的医院的 FTR 几率明显更高（比值比 1.97 [1.50-2.59]）。结论 高风险诊断的新生儿医院死亡率的显着变化似乎不能用医院结构特征来解释。相反，FTR 的差异表明，针对术后并发症的早期识别和管理的质量改进干预措施可以提高高危新生儿护理的手术质量和安全性。