Parental preferences for pediatric surgical facility centralization: insights from a discrete choice experiment.

Abstract

Purpose: This study aimed to quantify the trade-off between benefits of pediatric surgical facility centralization and reduced accessibility.

Methods: A discrete choice experiment was conducted among parents of neonatal patients at Takatsuki Hospital (January 2021 to March 2024). Hypothetical facilities with varying levels of seven attributes-surgeon numbers and emergency coverage (EC), annual surgical volume, travel time, availability of pediatric specialists, advanced surgical capability, postoperative complication rates, and primary physician system-were presented. Preferences for each attribute and marginal rates of substitution with respect to travel time were estimated.

Results: We analyzed 317 sets from 646 responses. Preferences were significantly influenced by surgeon numbers and EC, annual surgical volume, and travel time. Compared to "one surgeon/no EC," "three surgeons/daytime EC" and "seven surgeons/24 h EC" were valued equivalent to 99 and 249 min travel time increases. "Medium (≥ 1, < 6 cases/year)" and "high (≥ 6 cases/year)" were preferred over "low (< 1 case/year)" surgical volumes, equivalent to 123 and 219 min increases. Availability of other specialists (64 min), advanced surgery (33 min), and lower complications (24 min) were also valued. Team-based care was less preferred (- 26 min).

Conclusion: Parents support centralization of pediatric surgical facilities, placing greater emphasis on structural improvements than direct clinical outcomes.