Abstract：
Studies of neurosurgical pediatric patients associate treatment at low-volume hospitals and by low-volume surgeons with increased odds of adverse outcomes. Although these associations suggest that increased centralization of care could be considered, we evaluate whether confounding endogenous factors mitigate against the proposed outcome benefits.
Literature review of English language articles from 1999 to 2021. We included articles that assessed volume-outcome effects in pediatric neurosurgical patients.
Twelve papers were included from 1999 to 2021. Primary outcomes included mortality (9), length of stay (LOS) (6), complications (4), and shunt revision/failure rates (3). Volume was measured at the hospital level (8) and at the surgeon level (6). Four papers found that higher volume hospitals had lower odds of mortality. Two papers found that hospitals with higher volume had fewer complications. Two papers found that higher volume surgeons had decreased mortality (odds ratio [OR] 0.09-0.3). One paper found that high-volume surgeons had fewer complications (-2.4%; P = 0.006). After controlling for hospital factors (HF), two out of 7 analyses remained significant. Five analyses did not control for HF.
The literature consistently demonstrates a relationship between higher hospital and surgeon volume and better outcomes for pediatric neurosurgical patients. Of the 7 articles that assessed HF, only 2 analyses found that surgical volume remained associated with better outcomes. No reports assessed the degree of centralization already present. The call for centralization of pediatric care should be tempered until variables such as hospital factors, distribution of cases, and clinical thresholds can be defined and studied.
Literature review of English language articles from 1999 to 2021. We included articles that assessed volume-outcome effects in pediatric neurosurgical patients.
Twelve papers were included from 1999 to 2021. Primary outcomes included mortality (9), length of stay (LOS) (6), complications (4), and shunt revision/failure rates (3). Volume was measured at the hospital level (8) and at the surgeon level (6). Four papers found that higher volume hospitals had lower odds of mortality. Two papers found that hospitals with higher volume had fewer complications. Two papers found that higher volume surgeons had decreased mortality (odds ratio [OR] 0.09-0.3). One paper found that high-volume surgeons had fewer complications (-2.4%; P = 0.006). After controlling for hospital factors (HF), two out of 7 analyses remained significant. Five analyses did not control for HF.
The literature consistently demonstrates a relationship between higher hospital and surgeon volume and better outcomes for pediatric neurosurgical patients. Of the 7 articles that assessed HF, only 2 analyses found that surgical volume remained associated with better outcomes. No reports assessed the degree of centralization already present. The call for centralization of pediatric care should be tempered until variables such as hospital factors, distribution of cases, and clinical thresholds can be defined and studied.
摘要：
背景：对神经外科儿科患者的研究将低容量医院和低容量外科医生的治疗与不良结局的几率增加相关联。尽管这些关联表明可以考虑增加护理的集中化，我们评估混杂的内源性因素是否会降低所提出的结局获益.
方法：1999-2021年英语文章的文献综述。我们纳入了评估小儿神经外科患者体积结局影响的文章。
结果：从1999年到2021年共收录了12篇论文。主要结果包括死亡率（9），住院时间（LOS）（6），并发症（4），和分流修正/故障率（3）。在医院级别（8）和外科医生级别（6）测量体积。四篇论文发现，容量较大的医院死亡率较低。两篇论文发现，容量较大的医院并发症较少。两篇论文发现，更大量的外科医生降低了死亡率（OR0.09-0.3）。一篇论文发现，高容量外科医生的并发症较少（-2.4％；P=0.006）。在控制医院因素后，7项分析中有2项仍然具有重要意义.五项分析未控制医院因素。
结论：文献一致证明了较高的医院和外科医生容量与小儿神经外科手术患者更好的预后之间的关系。在评估医院因素的七篇文章中，只有两项分析发现手术体积仍然与更好的结局相关.没有报告评估已经存在的集中化程度。儿科护理集中化的呼吁应该得到缓和，直到医院因素等变量，案件分布,和临床阈值可以定义和研究。
方法：1999-2021年英语文章的文献综述。我们纳入了评估小儿神经外科患者体积结局影响的文章。
结果：从1999年到2021年共收录了12篇论文。主要结果包括死亡率（9），住院时间（LOS）（6），并发症（4），和分流修正/故障率（3）。在医院级别（8）和外科医生级别（6）测量体积。四篇论文发现，容量较大的医院死亡率较低。两篇论文发现，容量较大的医院并发症较少。两篇论文发现，更大量的外科医生降低了死亡率（OR0.09-0.3）。一篇论文发现，高容量外科医生的并发症较少（-2.4％；P=0.006）。在控制医院因素后，7项分析中有2项仍然具有重要意义.五项分析未控制医院因素。
结论：文献一致证明了较高的医院和外科医生容量与小儿神经外科手术患者更好的预后之间的关系。在评估医院因素的七篇文章中，只有两项分析发现手术体积仍然与更好的结局相关.没有报告评估已经存在的集中化程度。儿科护理集中化的呼吁应该得到缓和，直到医院因素等变量，案件分布,和临床阈值可以定义和研究。
