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Surgical Interventions During End-of-Life Hospitalizations in Children's Hospitals
Michael D Traynor1, Ryan M Antiel2, Maraya N Camazine1,3
1Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Pediatrics
|December 1, 2021
Summary
Nearly half of pediatric patients receive surgery during terminal hospitalizations. Surgical patterns varied by age, race, and chronic complex conditions, highlighting disparities in end-of-life care.
Area of Science:
- Pediatric Surgery
- Palliative Care
- Health Disparities
Background:
- Pediatric terminal hospitalizations involve complex care decisions.
- Surgical interventions are a component of end-of-life care for children.
Purpose of the Study:
- To characterize surgical patterns in pediatric patients during terminal hospitalizations.
- To identify factors influencing the utilization of surgery in this population.
Main Methods:
- Retrospective review of 33,693 terminal hospitalizations in US children's hospitals (2013-2019).
- Analysis of surgical procedures using International Classification of Diseases codes.
- Statistical testing for variations in surgery by age, race/ethnicity, and chronic complex conditions (CCCs).
Main Results:
- 49.7% of pediatric patients underwent surgery during terminal hospitalization, with a declining trend over time.
- Common surgical purposes included hardware/catheter management, diagnosis, and life-saving interventions.
- Surgery rates differed significantly by race/ethnicity and patient age, with disparities noted.
Conclusions:
- Pediatric surgical care is integral to end-of-life care in hospitals.
- Observed racial and ethnic differences in surgery may reflect access to or preferences for non-hospital-based palliative and hospice care.
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