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Pediatric specialist care is associated with a lower risk of bowel resection in children with intussusception: a
Jarod P McAteer1, Steve Kwon, Cabrini A LaRiviere
1Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA. jarodmc@u.washington.edu
Insights
Hospitals without pediatric surgeons are more likely to perform bowel resection for intussusception reduction, leading to increased complications. Standardizing care can improve outcomes for pediatric intussusception patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Services Research
Background:
- Radiologic intussusception reduction is more common at children's hospitals.
- Outcomes of surgical intussusception reduction have not been compared between hospital types.
- This study investigates if bowel resection rates differ between hospitals with and without pediatric surgeons.
Purpose of the Study:
- To compare the rates of bowel resection during operative intussusception reduction between pediatric and non-pediatric hospitals.
- To identify factors associated with bowel resection in pediatric intussusception cases.
- To assess the impact of bowel resection on postoperative complications.
Main Methods:
- Population-based retrospective cohort study using Washington State discharge records (1999-2009).
- Included 327 children (<18 years) undergoing operative intussusception reduction.
- Multivariate logistic regression analyzed odds of intestinal resection.
Main Results:
- Bowel resection was more common at non-pediatric hospitals (59.3% vs 33.0%).
- Pediatric hospitals had lower odds of bowel resection (OR 0.20, p < 0.001), especially in younger patients.
- Bowel resection was associated with increased postoperative complications (OR 2.83, p < 0.001).
Conclusions:
- Hospitals without pediatric surgeons are more likely to perform bowel resection for intussusception.
- Bowel resection during operative intussusception reduction is linked to higher complication rates.
- Standardizing care may improve outcomes for pediatric intussusception.
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.
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