Timing of enterostomy closure for neonatal isolated intestinal perforation.
J Pediatr Surg
; 55(8): 1535-1541, 2020 Aug.
Article
em En
| MEDLINE
| ID: mdl-31954555
ABSTRACT
PURPOSE:
No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost.METHODS:
Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 11 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons.RESULTS:
Prior to matching, the basic demographics of our study population included a median birthweight of 960â¯g, mean gestational age of 29.5â¯weeks, and average age at admission of 4â¯days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR 1.91; 95% CI for HR 1.44-2.53; pâ¯<â¯.0001). The median length of stay for A1 was 95â¯days (95% CI 78-102â¯days) versus A2 length of stay of 67â¯days (95% CI 56-76â¯days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR 0.78; 95% CI for RR 0.64-0.95; p-valueâ¯=â¯0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (pâ¯<â¯0.001).CONCLUSION:
Neonates with IIP have a 28â¯day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22â¯day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions. TYPE OF STUDY Prognosis Study. LEVEL OF EVIDENCE Level II.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Enterostomia
/
Perfuração Intestinal
Tipo de estudo:
Prognostic_studies
Limite:
Humans
/
Newborn
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
2020
Tipo de documento:
Article