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Postoperative complications and health care use in children undergoing surgery for ulcerative colitis

Lorraine I Kelley-Quon1, Chi-Hong Tseng, Howard C Jen

  • 1Division of Pediatric Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7098, USA.

Journal of Pediatric Surgery
|November 21, 2012
PubMed

Insights

Children with ulcerative colitis (UC) have high hospital use before colectomy, which decreases after surgery. Pediatric colectomy at children's hospitals and high-volume centers reduces complications and hospitalization duration.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Health services research

Background:

  • Medical and surgical management of pediatric ulcerative colitis (UC) varies.
  • Understanding healthcare utilization and complication rates is crucial for optimizing treatment pathways.
  • Restorative proctocolectomy is a significant surgical intervention for children with UC.

Purpose of the Study:

  • To define hospital use and complication rates in children with UC before and after staged restorative proctocolectomy.
  • To identify factors influencing hospital resource utilization and surgical outcomes.
  • To compare outcomes based on hospital type and surgical volume.

Main Methods:

  • Retrospective analysis of the California Patient Discharge Dataset (1999-2007).
  • Inclusion of children aged 2-18 years with UC undergoing colectomy (N=218).
  • Analysis of surgical staging, hospital type, case volume, postoperative complications, and length of stay using multivariate regression.

Main Results:

  • 65% of patients required prior hospital admissions; mean admissions decreased from 1.8 to 0.7 post-colectomy.
  • Surgical complications occurred in 49% of patients, with infection being common (39%).
  • Increased complication risk was associated with public insurance (OR 2.18) and non-children's hospitals (OR 2.53). Prolonged hospitalization linked to nonwhite race, surgical staging, and lower hospital volume.

Conclusions:

  • Children with UC utilize significant hospital resources pre-surgery, with reduced utilization post-completion.
  • Pediatric colectomy at children's hospitals and high-volume centers is associated with fewer complications and shorter hospitalizations.
  • Optimizing surgical care for pediatric UC patients involves careful consideration of hospital type and volume.
Abstract

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