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Implications of transfer status on bowel loss in children undergoing emergency surgery for malrotation

Stephanie F Polites1, Timothy B Lautz2, Todd M Jenkins1

  • 1Division of General and Thoracic Pediatric Surgery, Cincinnati, Children's Hospital Medical Center.

Journal of Pediatric Surgery
|April 21, 2019
PubMed

Insights

Children transferred for emergent surgery for malrotation are more likely to need bowel resection, increasing morbidity. Addressing transfer disparities is crucial for timely pediatric surgical care.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Surgical Outcomes

Background:

  • Malrotation with midgut volvulus is a critical pediatric surgical emergency requiring prompt intervention.
  • Timely access to specialized pediatric surgical care is essential to prevent bowel loss.

Purpose of the Study:

  • To investigate disparities in bowel resection rates among children undergoing emergency surgery for malrotation.
  • To assess the impact of hospital transfer status on surgical outcomes in pediatric malrotation.

Main Methods:

  • A multicenter cohort study using the Pediatric Health Information System.
  • Analysis of factors associated with bowel resection, surgical complications, prolonged length of stay, TPN dependence, and mortality.
  • Univariate and multivariable regression analyses were employed.

Main Results:

  • Of 3373 patients, 44.8% were transferred; transfer was associated with younger age, prematurity, comorbidities, nonwhite race, and public insurance.
  • Transferred patients had significantly higher rates of bowel resection (30.7% vs. 16.4%, p < .001).
  • After adjusting for bowel resection, only patient factors (age, comorbidity) predicted complications, TPN dependence, and death.

Conclusions:

  • Hospital-to-hospital transfer for emergent malrotation surgery increases the likelihood of bowel resection and subsequent morbidity.
  • Disparities in transfer status based on race and insurance highlight the need for improved access to prompt surgical care.
Abstract

Keywords:
Bowel resectionDisparityMalrotationPediatric surgeryTransfer

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