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Published on: October 29, 2014
Variation in surgical outcomes for adolescents and young adults with inflammatory bowel disease
Sophia Jan1, Gail Slap, Dingwei Dai
1Division of General Internal Medicine, Perelman School of Medicine of University of Pennsylvania, Philadelphia, Pennsylvania, USA. jans@email.chop.edu
Insights
Surgical outcomes for inflammatory bowel disease (IBD) patients aged 16-25 varied by hospital type and surgeon specialty. Children's hospitals had more complications, but pediatric surgeons had better outcomes, highlighting the need for tailored care approaches.
Area of Science:
- Gastroenterology
- Surgical Outcomes Research
- Health Services Research
Background:
- Adolescents and young adults with inflammatory bowel disease (IBD) often require surgery.
- Outcomes for this population may vary based on the healthcare setting and surgical expertise.
- Understanding these variations is crucial for optimizing patient care.
Purpose of the Study:
- To determine if hospital type (children's vs. generalist) and surgeon specialty impact surgical outcomes in young IBD patients.
- To analyze the association between practice setting, surgical specialty, and post-operative complications or readmissions.
Main Methods:
- Retrospective cohort study using the 2007-2009 Perspective Data Warehouse.
- Inclusion of inpatients aged 16-25 undergoing surgery for IBD.
- Multivariate regression analysis, clustered at the hospital level, to assess outcomes.
Main Results:
- Children's hospitals showed higher predicted probabilities of surgical complications (35%) compared to general hospitals (26%).
- Pediatric surgeons demonstrated the lowest predicted probabilities for complications or 30-day readmissions (24%).
- General surgeons (39%) and colorectal surgeons (35%) had higher predicted complication rates.
Conclusions:
- Significant disparities in surgical outcomes exist for young IBD patients based on hospital type and surgeon specialty.
- The findings underscore the importance of considering practice setting and surgical expertise in managing this patient group.
- Further research is needed to elucidate how these factors modify outcomes across diverse healthcare settings.
Objective:
To examine whether hospital type (children's hospital or generalist hospital) and surgeon specialty are associated with variations in surgical outcomes for hospitalized adolescents and young adults with inflammatory bowel disease (IBD) requiring surgery.
Methods:
The 2007-2009 Perspective Data Warehouse was used to identify a retrospective cohort study of all inpatients 16 to 25 years old who received surgery for IBD. Multivariate regression, clustered at the hospital level, examined the association of hospital type and surgical specialty with surgical complications and 30-day readmissions.
Results:
Surgery was performed in 917 hospitalizations of 598 patients across 20 children's hospitals and 198 general hospitals by 566 general surgeons, 46 pediatric surgeons, and 305 colorectal surgeons. After adjustment, children's hospitals had higher predicted probabilities of surgical complication (predicted probability [PP]: 35% [95% confidence interval (CI): 28-42]) compared with general hospitals (PP: 26% [95% CI: 23-29]). Despite higher complications among children's hospitals, pediatric surgeons had lowest predicated probabilities of surgical complication or 30-day readmission (PP: 24% [95% CI: 10-39]) compared with general surgeons (PP: 39% [95% CI: 35-43]) and colorectal surgeons (PP: 35% [95% CI: 28-42]).
Conclusions:
Disparate outcomes for adolescents and young adults receiving care in children's versus generalist hospitals and from different types of surgeons reveal the need to better understand how practice setting and surgical specialty may modify outcomes for a population that traverses a variety of health care settings.
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