Pediatric surgery is a "field that pushes us to do more," he says. Referring to minimally invasive procedures, he says parents of children "don't want bigger incisions, they don't want to stay in the hospital longer, and they want less pain.
"Surgery is a major driver of profit in hospitals, but not as much in kids," says Karrer. To augment surgery programs, hospitals are diversifying into specialized areas, he says. Generally, the hospital has seen 5% to 10% increases in various elements of pediatric surgery in recent years, in areas such as its trauma center, liver transplant program, and the colorectal and bariatric surgery programs.
The specialty programs have made good business sense for the hospital and have improved patient outcomes. The trauma program is a leading component of pediatric patient care because trauma injury is one of the major causes of childhood death and disability, he says. The hospital also has measured increased success rates in its liver transplant program, having a 95% patient survival rate and a 91% graft survival rate, which exceed the national averages by at least 5%, according to Karrer.
Success Key No. 1: Minimally invasive surgery
More hospitals are working on minimally invasive surgery in some of the most complicated settings, which is effectively reducing children's pain and improving surgical conditions.
At the 286-bed Children's Hospital Los Angeles, physicians are using transoral robotic surgery under the da Vinci surgical system, which is also the method for strengthening surgical outcomes by providing greater visualization techniques and improved precision.
"We have raised the bar to achieve high success rates. In many ways, open surgery is still the gold standard, but we can't wait on the sidelines, and [TORS] is becoming less complicated and the success rates are there," says Chester Koh, director of robotic surgery at the Children's Hospital Los Angeles, where he also serves as attending surgeon in the division of pediatric urology.
While the success rate reaches 95% for open surgery, the rate with the robot is about 90% and still improving, he says. However, there are other factors that are pushing hospitals to opt for the robot: less pain, less medication, less scarring, and improved patient discharge rates, Koh says.
Even though the cost of the equipment is greater and it takes longer to carry out the task, the driver for hospitals may not be those costs as much as the improved outcomes. In that way, the marketing aspect becomes a factor because word spreads among parents and relatives about satisfaction with children's surgeries, Koh says.
At the 205-bed Johns Hopkins Children's Center in Baltimore, surgeons are using video-assisted procedures for the tiniest infants, says Jeffrey Lukish, MD, pediatric surgeon at Johns Hopkins. The common denominator for all minimally invasive procedures, he says, is to reduce pain, drug usage, and operative and postoperative time. Lukish, a former chief of pediatric surgery at the National Naval Medical Center and the Walter Reed Army Medical Center, has developed and refined a number of minimally invasive surgical techniques, including those for thorascopic PDA ligation and hernias.