Medical College of Wisconsin
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Pediatric specialist care is associated with a lower risk of bowel resection in children with intussusception: a population-based analysis. J Am Coll Surg 2013 Aug;217(2):226-32.e1-3 PMID: 23664141

Pubmed ID

23664141

DOI

10.1016/j.jamcollsurg.2013.02.033

Abstract

BACKGROUND: Although previous studies have shown that radiologic intussusception reduction is more likely at children's hospitals, no study to date has compared outcomes among children advancing to surgical intervention. We hypothesized that rates of bowel resection would differ between hospitals with and without pediatric surgeons.

STUDY DESIGN: We conducted a population-based retrospective cohort study using Washington State discharge records. All children younger than 18 years undergoing operative intussusception reduction between 1999 and 2009 were included (n = 327). Data were collected on demographics, disease severity, comorbidities, and concomitant gastrointestinal pathology. Multivariate logistic regression was used to estimate odds of intestinal resection during operative intussusception reduction.

RESULTS: Pediatric hospitals treated a smaller proportion of children older than 4 years of age (12.1% vs 44.4%), as well as a greater proportion of Medicaid patients (50.9% vs 42.6%). Patients at pediatric hospitals had a lower prevalence of underlying intestinal anomalies or identifiable mass lesions (14.3% vs 16.7%). "Severe disease" (perforation, ischemia, acidosis) was more common at pediatric hospitals (17.6% vs 9.3%). Overall, bowel resection was more commonly performed at nonpediatric hospitals (59.3% vs 33.0%). On multivariate analysis, the odds of bowel resection were significantly lower at pediatric compared with nonpediatric hospitals (odds ratio [OR] 0.20, p < 0.001), and this association was strongest in younger patients. Adjusted odds of postoperative complications were greater for bowel resection patients (OR 2.83, p < 0.001).

CONCLUSIONS: Bowel resection during operative intussusception reduction is more likely at hospitals without pediatric surgeons, and is associated with increased complications. Improved outcomes may be achieved by efforts aimed at standardizing care and decreasing variability in the treatment of pediatric intussusception.

Author List

McAteer JP, Kwon S, LaRiviere CA, Oldham KT, Goldin AB

Author

Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84880573120   18 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cohort Studies
Databases, Factual
Digestive System Surgical Procedures
Female
General Surgery
Hospitals
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Intestines
Intussusception
Logistic Models
Male
Multivariate Analysis
Pediatrics
Postoperative Complications
Retrospective Studies
Risk
Severity of Illness Index
Treatment Outcome
Washington
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad