Table 6

Barriers by hospital level

Barrier (%)	First-level hospital	Second-level hospital	Third-level hospital	National children’s center	P value
Lack of anesthesia care	3	39	22	22	<0.01
Lack of equipment	71	76	56	58	0.02
Lack of access to operating rooms	27	30	27	34	0.85
Lack of essential medications	30	32	17	17	0.10
Lack of infrastructure (such as electricity, water, vacuum)	40	17	6	11	0.03
Lack of postoperative hospital beds	45	56	41	50	0.20
Difficulty obtaining reimbursement	71	72	53	49	0.03
Lack of more specialized training	28	39	29	17	0.03
Lack of reference systems for patient transfer	45	34	21	24	0.13
Poor patient access (geographical distance, low socioeconomic status)	77	35	37	46	0.05
No barriers	8	2	13	12	<0.01

Comparison of barriers reported by pediatric surgeons based on the hospital level where they perform the majority of their operations. Number is estimated based on sample weights, and percentages are based on weighted proportions. P values calculated using adjacent Wald χ² tests.