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Trends in pediatric spleen management: Do hospital type and ownership still matter?
Shaoming Liu1, Stephen M Bowman, Tyler C Smith
1From the Department of Community Health (S.L., T.C.S.), School of Health and Human Services, National University, San Diego, California; Department of Health Policy and Management (S.M.B.), Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Department of Anesthesiology (S.R.S.), School of Medicine, University of Washington, Seattle, Washington.
Insights
Nonoperative management for pediatric blunt splenic injury increased across hospital types, narrowing disparities. However, general hospitals lag behind children's hospitals in adopting this preferred treatment.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Health Services Research
Background:
- Nonoperative management (NOM) of blunt splenic injury is preferred over splenectomy due to better outcomes and fewer complications.
- Previous studies indicated treatment variability based on hospital profit types and ownership.
Purpose of the Study:
- To analyze trends in pediatric splenic injury management over a decade.
- To determine if disparities in NOM versus splenectomy by hospital type have changed.
Main Methods:
- Analysis of the Kid's Inpatient Database (2000-2009) for pediatric patients (≤18 years) with blunt splenic injury.
- Multivariable logistic regression to assess the impact of hospital profit and ownership on splenectomy rates.
- Treatment categorized as NOM (initial non-operative attempt) or operative management (splenectomy within 1 day).
Main Results:
- Nonoperative management rates increased in both not-for-profit (71.0% to 84.6%) and for-profit (83.8% to 87.5%) hospitals from 2000 to 2009.
- Splenectomy rates significantly decreased between 2000 and 2003 (OR, 0.66).
- Children's hospitals maintained high NOM rates (98.6% in 2009), serving as a benchmark.
Conclusions:
- Improved rates of nonoperative management for pediatric spleen injuries were observed across hospital types.
- General hospitals did not consistently achieve the target of 90% nonoperative management.
- Further research is needed to optimize pediatric splenic injury management in general hospitals.
Background:
Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership.
Methods:
Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission.
Results:
Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management.
Conclusion:
Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals.
Levels Of Evidence:
Epidemiologic and prognostic study, level III.
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