{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:20:17Z","timestamp":1787062817446,"version":"build-2736575974"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The impact of procedural volume on the outcomes of cerebrovascular surgery in children has not been determined. In this study, the authors investigated the association of operative volume on the outcomes of cerebrovascular neurosurgery in pediatric patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a cohort study of all pediatric patients who underwent a cerebrovascular procedure between 2003 and 2012 and were registered in the Kids' Inpatient Database (KID). To control for confounding, the authors used multivariable regression models, propensity-score conditioning, and mixed-effects analysis to account for clustering at the hospital level.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n During the study period, 1875 pediatric patients in the KID underwent cerebrovascular neurosurgery and met the inclusion criteria for the study; 204 patients (10.9%) underwent aneurysm clipping, 446 (23.8%) underwent coil insertion for an aneurysm, 827 (44.1%) underwent craniotomy for arteriovenous malformation resection, and 398 (21.2%) underwent bypass surgery for moyamoya disease. Mixed-effects multivariable regression analysis revealed that higher procedural volume was associated with fewer inpatient deaths (OR 0.58; 95% CI 0.40\u20130.85), a lower rate of discharges to a facility (OR 0.87; 95% CI 0.82\u20130.92), and shorter length of stay (adjusted difference \u22120.22; 95% CI \u22120.32 to \u22120.12). The results in propensity-adjusted multivariable models were robust.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In a national all-payer cohort of pediatric patients who underwent a cerebrovascular procedure, the authors found that higher procedural volume was associated with fewer deaths, a lower rate of discharges to a facility, and decreased lengths of stay. Regionalization initiatives should include directing children with such rare pathologies to a center of excellence.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.5.peds16137","type":"journal-article","created":{"date-parts":[[2016,8,5]],"date-time":"2016-08-05T10:00:19Z","timestamp":1470391219000},"page":"623-628","source":"Crossref","is-referenced-by-count":20,"title":["Operative volume and outcomes of cerebrovascular neurosurgery in children"],"prefix":"10.3171","volume":"18","author":[{"given":"Kimon","family":"Bekelis","sequence":"first","affiliation":[{"name":"Section of Neurosurgery, Dartmouth-Hitchcock Medical Center;"},{"name":"Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian D.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Departments of Radiology and Neurosurgery, Stanford University School of Medicine, Palo Alto; and"},{"name":"Department of Neurosurgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huy M.","family":"Do","sequence":"additional","affiliation":[{"name":"Departments of Radiology and Neurosurgery, Stanford University School of Medicine, Palo Alto; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Choudhri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds16137","series-title":"Variations in the Care of Surgical Conditions: A Dartmouth Atlas of Health Care Series","article-title":"Variation in the care of surgical conditions: cerebral aneurysms","author":"Bekelis","year":"2014"},{"key":"b2-peds16137","series-title":"J Neurointerv Surg","article-title":"Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes","author":"Bekelis","year":"2015"},{"key":"b3-peds16137","series-title":"J Neurosurg","article-title":"The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms","author":"Bekelis"},{"key":"b4-peds16137","series-title":"J Neurointerv Surg","article-title":"Continuity of care and 30-day readmission for patients evaluated in the emergency room after cerebral aneurysm treatment","author":"Bekelis","year":"2016"},{"key":"b5-peds16137","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1056\/NEJMsa012337","article-title":"Hospital volume and surgical mortality in the United States","volume":"346","author":"Birkmeyer","year":"2002"},{"key":"b6-peds16137","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMsa035205","article-title":"Surgeon volume and operative mortality in the United States","volume":"349","author":"Birkmeyer","year":"2003"},{"issue":"6","key":"b7-peds16137","series-title":"Neurosurg Focus","first-page":"E9","article-title":"History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms","volume":"20","author":"Blount","year":"2006"},{"issue":"6","key":"b8-peds16137","series-title":"Neurosurg Focus","first-page":"E10","article-title":"History of surgery for cerebrovascular disease in children. Part II. Vein of Galen malformations","volume":"20","author":"Blount","year":"2006"},{"issue":"6","key":"b9-peds16137","series-title":"Neurosurg Focus","first-page":"E11","article-title":"History of surgery for cerebrovascular disease in children. Part III. Arteriovenous malformations","volume":"20","author":"Blount","year":"2006"},{"key":"b10-peds16137","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.3174\/ajnr.A2938","article-title":"Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments","volume":"33","author":"Brinjikji","year":"2012"},{"key":"b11-peds16137","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3174\/ajnr.A2739","article-title":"Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the United States are substantially higher than Medicare payments","volume":"33","author":"Brinjikji","year":"2012"},{"key":"b12-peds16137","series-title":"J Neurointerv Surg","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1136\/neurintsurg-2013-010811","article-title":"Cerebral aneurysm treatment is beginning to shift to low volume centers","volume":"6","author":"Brinjikji","year":"2014"},{"key":"b13-peds16137","series-title":"J Crit Care","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.jcrc.2015.01.007","article-title":"Impact of case volume on aneurysmal subarachnoid hemorrhage outcomes","volume":"30","author":"Chang","year":"2015"},{"key":"b14-peds16137","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1056\/NEJMsa1010705","article-title":"Trends in hospital volume and operative mortality for high-risk surgery","volume":"364","author":"Finks","year":"2011"},{"key":"b15-peds16137","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.jocn.2006.12.002","article-title":"Can a \u201cnovice\u201d do aneurysm surgery? Surgical outcomes in a low-volume, non-subspecialised neurosurgical unit","volume":"14","author":"Goldschlager","year":"2007"},{"key":"b16-peds16137","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"95","DOI":"10.2176\/nmc.47.95","article-title":"Case volume does not correlate with outcome after cerebral aneurysm clipping: a nationwide study in Japan","volume":"47","author":"Hattori","year":"2007"},{"key":"b17-peds16137","series-title":"Pediatr Neurosurg","first-page":"66","article-title":"Pediatric intracranial aneurysms: simple and complex cases","volume":"17","author":"Herman","year":"1992"},{"key":"b18-peds16137","series-title":"AJNR Am J Neuroradiol","first-page":"1409","article-title":"In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996\u20132000: effect of hospital and physician volume","volume":"24","author":"Hoh","year":"2003"},{"key":"b19-peds16137","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1161\/01.STR.31.1.111","article-title":"Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes","volume":"31","author":"Johnston","year":"2000"},{"key":"b20-peds16137","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3171\/2014.3.PEDS13444","article-title":"Revascularization and pediatric aneurysm surgery","volume":"13","author":"Kalani","year":"2014"},{"key":"b21-peds16137","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/PL00007286","article-title":"Clinical feature and outcome of pediatric cerebrovascular disease: a neurosurgical series","volume":"16","author":"Kim","year":"2000"},{"key":"b22-peds16137","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1776","DOI":"10.1161\/01.STR.0000174293.17959.a1","article-title":"Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10","volume":"36","author":"Kokotailo","year":"2005"},{"issue":"2 Suppl","key":"b23-peds16137","series-title":"J Neurosurg","first-page":"82","article-title":"Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management","volume":"104","author":"Sanai","year":"2006"},{"key":"b24-peds16137","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1161\/01.STR.0000032240.28636.BD","article-title":"Validating administrative data in stroke research","volume":"33","author":"Tirschwell","year":"2002"},{"key":"b25-peds16137","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.nec.2010.03.001","article-title":"Pediatric and inherited neurovascular diseases","volume":"21","author":"Vanaman","year":"2010"},{"key":"b26-peds16137","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1161\/STROKEAHA.113.004412","article-title":"Variability in outcome after elective cerebral aneurysm repair in high-volume academic medical centers","volume":"45","author":"Zacharia","year":"2014"},{"key":"b27-peds16137","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2844","DOI":"10.1161\/STROKEAHA.111.619767","article-title":"Technological advances in the management of unruptured intracranial aneurysms fail to improve outcome in New York state","volume":"42","author":"Zacharia","year":"2011"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p623.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p623.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/18\/5\/article-p623.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T09:11:06Z","timestamp":1681549866000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/18\/5\/article-p623.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11]]},"references-count":27,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2016.5.peds16137","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11]]}}}