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Intussusception: hospital size and risk of surgery
S L Bratton1, C M Haberkern, J H Waldhausen
1Department of Pediatrics, Oregon Health Sciences University and Doernbecher Children's Hospital, Portland, Oregon, USA. sbratton@umich.edu
Insights
Children with intussusception treated at large children's hospitals had less surgery and lower costs. These findings suggest hospital size impacts pediatric intussusception care outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Services Research
Background:
- Intussusception is a common surgical emergency in infants and children.
- Treatment approaches include operative and nonoperative management.
- Hospital pediatric caseload may influence treatment decisions and outcomes.
Purpose of the Study:
- To investigate if the risk of operative management for pediatric intussusception varies based on hospital size and pediatric caseload.
- To compare outcomes, including length of stay and hospital charges, between different hospital settings.
Main Methods:
- Retrospective cohort study of children diagnosed with intussusception in Washington State (1987-1996).
- Identified 570 children with intussusception; 62 were excluded due to missing data.
- Analyzed procedure codes for operative and radiologic management, stratifying by hospital pediatric caseload.
Main Results:
- 53% of children underwent operative reduction, and 20% had bowel resection.
- Children receiving operative care were more likely to be in hospitals with smaller pediatric caseloads.
- Large children's hospitals had higher rates of nonoperative reduction (64%) compared to smaller hospitals.
- Median length of stay and hospital charges were lower in large children's hospitals.
Conclusions:
- Children treated for intussusception at large children's hospitals experienced a reduced risk of operative intervention.
- Care in large children's hospitals was associated with shorter hospital stays and lower overall charges.
- Hospital pediatric caseload is a significant factor influencing the management and outcomes of pediatric intussusception.
Objective:
To determine whether the risk of operative management of children with intussusception varies by hospital pediatric caseload.
Design:
A cohort of all children with intussusception in Washington State from 1987 through 1996.
Setting:
All hospitals in Washington State.
Methods:
Five hundred seventy children with a hospital discharge diagnosis of intussusception were identified. Sixty-two were excluded because of missing data. Procedure codes for operative management and radiologic management were also identified.
Results:
Fifty-three percent of the children had operative reduction and 20% had resection of bowel. Children with operative reduction did not differ from those with nonoperative care by median age or gender; however, children with operative care were significantly more likely to receive care in hospitals with smaller pediatric caseloads and to have a coexisting condition associated with intussusception. Sixty-four percent of children who received care in a large children's hospital had nonoperative reduction, compared with 36% of children who received care in hospitals with 0 to 3000 annual pediatric admissions and 24% of children who had care in hospitals with 3000 to 10 000 annual pediatric admissions. Median length of stay and charges were significantly less in the large children's hospital, compared with other centers.
Conclusions:
Children who received care for intussusception in a large children's hospital had decreased risk of operative care, shorter length of stay, and lower hospital charges compared with children who received care in hospitals with smaller pediatric caseloads.
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