The impact of hospital type and experience on the operative utilization in pediatric intussusception: a nationwide
1Mattel Children's Hospital, University of California Los Angeles Medical Center, CA 90095, USA.
Insights
Pediatric intussusception cases treated at children's hospitals (CH) had lower operation rates compared to non-children's hospitals (NCH). Increased hospital experience at CH led to reduced operative utilization and higher rates of successful radiologic reduction.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Health services research
Background:
- Intussusception is a common surgical emergency in infants and children.
- Hospital experience and designation may influence clinical outcomes for pediatric intussusception.
Purpose of the Study:
- To evaluate the impact of hospital type (children's vs. non-children's hospitals) and experience on clinical outcomes for pediatric idiopathic intussusception in the US.
Main Methods:
- Retrospective analysis of 1263 children (2 months to 3 years) with idiopathic intussusception using the 2000 and 2003 Kid's Inpatient Database.
- Key outcomes measured: rates of surgery and radiologic reduction.
- Statistical significance set at P < .05.
Main Results:
- Children's hospitals (CH) had higher median intussusception volume (2.5 vs. 0.5 cases/year) than non-children's hospitals (NCH).
- CH treatment was associated with lower operative rates (55% vs. 68%) and higher radiologic reduction rates (39% vs. 26%).
- Multivariate analysis revealed a 17% reduction in operative utilization at CH, with high-volume hospitals showing a 19% reduction.
Conclusions:
- Pediatric intussusception patients treated at CH experience decreased likelihood of surgery compared to NCH.
- Increased hospital experience and greater use of radiologic reduction at CH contribute to improved outcomes.
Purpose:
To determine the impact in clinical outcomes of pediatric idiopathic intussusceptions from hospital experience and designation as children's hospitals (CH) and non-children's hospitals (NCH) in the US.
Methods:
A retrospective study was performed on 1263 children with idiopathic intussusception, 2 months to 3 years of age in 2000 and 2003 by extracting data from the Healthcare Cost and Utilization Project Kid's Inpatient Database. Main outcome measures were utilizations of operation and radiologic reduction. Statistical significance was defined as P < .05.
Results:
The median hospital volume of intussusceptions was higher at CH (2.5 vs 0.5 cases per year, P < .001) compared to NCH. Children treated at CH had lower risk of operation (55 vs 68%, P < .001) and higher likelihood of radiologic reduction (39 vs 26%, P < .001) compared to NCH. Multivariate regression analysis showed a 17% reduction of operative utilization at CH vs NCH. Outcomes were positively related to experience as high-volume hospitals reduced operative utilization by 19%. Rates of successful radiologic reduction were similar between hospital types, which was 85% nationally.
Conclusion:
Children with intussusception have decreased likelihood of operation when treated at CH compared to NCH. This decreased operative utilization can be attributed to the increased experience and utilization of radiologic reduction at these specialty hospitals.