Jennifer Cooper
Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital
294 – Epidemiologic Methods for the Re-Use of Existing Data
Regression Splines and Multi-Group Propensity Score Weighting for the Study of Surgical Volume-Outcome Relationships: Neonatal Esophageal Atresia/Tracheoesophageal Fistula As An Example
Jennifer Cooper
Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital
Studies of associations between surgeon or hospital operative volumes and postoperative outcomes often simply select volume thresholds to ensure an equal number of patients across categories. Such studies also rarely define volume as time-varying and seldom evaluate the interaction between surgeon and hospital volumes. We demonstrate the combined use of regression splines to identify volume thresholds and multi-group propensity score weighting to estimate the effects of both surgeon and hospital volumes on surgical outcomes. We studied infants who underwent surgery for esophageal atresia/tracheoesophageal fistula (EA/TEF), a rare congenital anomaly, at US children's hospitals in 2000-2015. We defined surgeon and hospital operative volumes as the number of patients receiving this surgery from the provider in the previous 365 days. We identified no volume thresholds in the relationships between either surgeon or hospital volume and postsurgical outcomes among EA/TEF patients. Furthermore, outcomes did not differ across four groups defined by the intersection of surgeon and hospital volumes dichotomized at their upper tertiles.