Assessment of care timelines in intestinal malrotation with volvulus: A retrospective chart review
Denise Sabac1, Daniel Briatico2, Peter Fitzgerald3
1Bachelor of Health Sciences (Honours) Program, McMaster University, Hamilton, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada.
Background:
Patients with intestinal malrotation with volvulus (MWV) may suffer bowel ischemia, which can be correlated with the timing of surgical intervention. The purpose of this study was to identify and assess time-blocks in the care of patients from initial physician assessment (IPA) to surgical intervention to highlight potential opportunities for improvement.
Methods:
Retrospective chart review of patients with MWV presenting to McMaster Children's Hospital between January 1st, 2000 and December 31st, 2020 (n = 31). Demographic data and time-blocks of care were identified and analyzed (p < 0.05 considered significant). All times were reported as medians.
Results:
22 males (71%) and 9 females (29%) were identified; median age was 9.8 d. IPA to incision was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients <1 y was not significantly different than those >1 y (10.5hrs vs 10.7hrs, p = 0.737). The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs, p = 0.128). For patients requiring resection or having pan-necrosis there was no significant difference in time from IPA (10.9hrs vs 10.5hrs, p = 0.238) or surgical consult to incision (4.0hrs vs 3.3hrs, p = 0.808).
Conclusion:
Time from IPA to surgical consult and time from surgical consult to surgical intervention represented the largest proportions of time. Age, use of ultrasound, and need for resection or having pan-necrosis did not significantly affect the time to incision. This data may be used to inform opportunities for expediting the management of patients with MWV once they have presented to a physician.
Level Of Evidence:
III.
Insights
Delays in surgical care for patients with malrotation with volvulus (MWV) are primarily between initial physician assessment and surgical consult. Expediting these critical time blocks can improve outcomes for pediatric surgical emergencies.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Malrotation with volvulus (MWV) poses a risk of bowel ischemia, directly linked to surgical timing.
- Prompt surgical intervention is crucial for mitigating complications in MWV patients.
Purpose of the Study:
- To analyze time intervals in the care pathway of MWV patients.
- To identify bottlenecks from initial physician assessment (IPA) to surgical intervention.
- To uncover opportunities for improving patient management and reducing delays.
Main Methods:
- Retrospective chart review of 31 MWV patients (2000-2020).
- Analysis of key time-blocks: IPA to incision, surgical consult to incision.
- Median times were calculated and compared across patient demographics and clinical factors.
Main Results:
- The longest delays occurred between IPA and surgical consult, and surgical consult and intervention.
- Time to incision was not significantly impacted by patient age (<1 year vs. >1 year).
- Ultrasound use and the need for resection or pan-necrosis did not significantly alter surgical timing.
Conclusions:
- The largest time expenditures in MWV patient care are pre-consult and pre-intervention phases.
- Age, diagnostic imaging modality, and severity of bowel necrosis do not significantly influence time to surgical intervention.
- Targeting improvements in the initial assessment and surgical consultation process is key to expediting MWV patient care.
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