1
|
Rosamilia G, Lee KH, Roy S, Hart C, Huang Z. Impact of COVID-19 on nationwide pediatric complicated sinusitis trends throughout 2018-2022. Am J Otolaryngol 2024; 45:104187. [PMID: 38134847 DOI: 10.1016/j.amjoto.2023.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To describe and analyze the trends of pediatric sinusitis cases from 2018 to 2022 across the country utilizing the Pediatric Hospital Information System (PHIS) database focusing on volumes, socioeconomics, and severity of cases. STUDY DESIGN Retrospective Cohort Study. METHODS A retrospective cohort study using the Pediatric Health Information System (PHIS) database, which consists of 50 children's hospitals was performed. Regions were defined according to PHIS guidelines. We evaluated percentage of sinusitis cases demographic and socioeconomic information and subgrouped by region throughout 2018-2022. RESULTS In all regions there were a greater number of sinusitis cases post-COVID compared to pre-COVID, with notable increases in major and extreme severity. The years 2020 and 2021 saw a decrease in total sinusitis cases in all locations. Both surgical intervention and severity of sinusitis were significant factors affecting length of stay. Age and severity were the most significant predictors regarding the odds of having sinus surgery. Age and insurance type were significant predictors of severity, with increasing age and government insurance associated with higher odds of major or extreme severity of sinusitis. CONCLUSIONS There appears to be a trend of both increased number and worsening severity of acute sinusitis cases in the post-COVID era compared to pre-COVID. There was a decrease in cases in 2020-2021 during the pandemic, consistent with trends of other communicable diseases.
Collapse
Affiliation(s)
- Gianna Rosamilia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America
| | - Kyung Hyun Lee
- Center for Clinical Research & Evidence-Based Medicine, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, United States of America
| | - Soham Roy
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Denver, CO, United States of America
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Zhen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, Houston, TX, United States of America.
| |
Collapse
|
2
|
Blinder JJ, Huang YS, Rossano JW, Costarino AT, Li Y. Variation in hospital costs and resource utilisation after congenital heart surgery. Cardiol Young 2023; 33:420-31. [PMID: 35373722 DOI: 10.1017/S1047951122001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Children undergoing cardiac surgery have overall improving survival, though they consume substantial resources. Nationwide inpatient cost estimates and costs at longitudinal follow-up are lacking. METHODS Retrospective cohort study of children <19 years of age admitted to Pediatric Health Information System administrative database with an International Classification of Diseases diagnosis code undergoing cardiac surgery. Patients were grouped into neonates (≤30 days of age), infants (31-365 days of age), and children (>1 year) at index procedure. Primary and secondary outcomes included hospital stay and hospital costs at index surgical admission and 1- and 5-year follow-up. RESULTS Of the 99,670 cohort patients, neonates comprised 27% and had the highest total hospital costs, though daily hospital costs were lower. Mortality declined (5.6% in 2004 versus 2.5% in 2015, p < 0.0001) while inpatient costs rose (5% increase/year, p < 0.0001). Neonates had greater index diagnosis complexity, greater inpatient costs, required the greatest ICU resources, pharmacotherapy, and respiratory therapy. We found no relationship between hospital surgical volume, mortality, and hospital costs. Neonates had higher cumulative hospital costs at 1- and 5-year follow-up compared to infants and children. CONCLUSIONS Inpatient hospital costs rose during the study period, driven primarily by longer stay. Neonates had greater complexity index diagnosis, required greater hospital resources, and have higher hospital costs at 1 and 5 years compared to older children. Surgical volume and in-hospital mortality were not associated with costs. Further analyses comprising merged clinical and administrative data are necessary to identify longer stay and cost drivers after paediatric cardiac surgery.
Collapse
|
3
|
Delany DR, Chowdhury SM, Corrigan C, Buckley JR. Preoperative in-hospital mortality in neonates with critical CHD. Cardiol Young 2022; 32:1794-1800. [PMID: 34961569 PMCID: PMC9462391 DOI: 10.1017/s1047951121004996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Data regarding preoperative mortality in neonates with critical CHD are sparse and would aid patient care and family counselling. The objective of this study was to utilise a multicentre administrative dataset to report the rate of and identify risk factors for preoperative in-hospital mortality in neonates with critical CHD across US centres. STUDY DESIGN The Pediatric Health Information System database was utilised to search for newborns ≤30 days old, born 1 January 2009 to 30 June 2018, with an ICD-9/10 code for d-transposition of the great arteries, truncus arteriosus, interrupted aortic arch, or hypoplastic left heart syndrome. Preoperative in-hospital mortality was defined as patients who died prior to discharge without an ICD code for cardiac surgery or interventional catheterisation. RESULTS Overall preoperative mortality rate was at least 5.4% (690/12,739) and varied across diagnoses (d-TGA 2.9%, TA 8.3%, IAA 5.5%, and HLHS 7.3%) and centres (0-20.5%). In multivariable analysis, risk factors associated with preoperative mortality included preterm delivery (<37 weeks) (OR 2.3, 95% CI: 1.8-2.9; p < 0.01), low birth weight (<2.5 kg) (OR 3.8, 95% CI: 3.0-4.7; p < 0.01), and genetic abnormality (OR 1.6, 95% CI: 1.2-2.2; p < 0.01). Centre average surgical volume was not a significant risk factor. CONCLUSION Approximately 1 in 20 neonates with critical CHD suffered preoperative in-hospital mortality, and rates varied across diagnoses and centres. Better understanding of the factors that drive the variation (e.g. patient factors, preoperative care models, surgical timing) could help identify patient care improvement opportunities and inform conversations with families.
Collapse
Affiliation(s)
- Dennis R Delany
- Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Corinne Corrigan
- Quality Management, Medical University of South Carolina, Charleston, SC, USA
| | - Jason R Buckley
- Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
4
|
Drapeau AI, Onwuka A, Koppera S, Leonard JR. Hospital Case-Volume and Patient Outcomes Following Pediatric Brain Tumor Surgery in the Pediatric Health Information System. Pediatr Neurol 2022; 133:48-54. [PMID: 35759803 DOI: 10.1016/j.pediatrneurol.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Markers of quality of care in various surgical specialties have been shown to correlate with hospital volumes. This study investigates the effect of hospital volume and patient-related factors on the outcomes of children undergoing brain tumor resection. METHODS We examined the data within the Pediatric Health Information System (PHIS) for children aged zero to 17 years undergoing brain tumor resection between 2016 and 2020. Length of hospital stay (LOS), costs, and reoperation rates were analyzed for associations with hospital case-volume, patient factors, and other hospital-related factors. RESULTS A total of 2568 patients were included in this PHIS analysis. After adjusting for covariates, care provided by high-case-volume hospitals led to shorter LOS (P = 0.01). The effect of hospital case-volume on median cost was present on univariate analysis (US $63,845 at low-volume hospital versus US $54,909 at high-volume hospital, P = 0.002); this finding was attenuated by LOS. A trend was observed between reoperation rates and hospital case-volume, with lowest quartile volume hospitals having higher odds of reoperation than hospitals with volumes in the highest quartile (P = 0.06). Racial and ethnic minorities, medical comorbidities, and other sociodemographic factors were associated with poorer outcomes following surgery. CONCLUSIONS Centering care around high-case-volume hospitals can potentially lead to shorter hospital stays and decreased costs for children with brain tumors. This PHIS article highlights the association of the studied outcomes with certain sociodemographic factors and illustrates that inequalities in pediatric health care still exist. Further efforts are required to understand and eliminate these potentially harmful differences.
Collapse
Affiliation(s)
- Annie I Drapeau
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio.
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey R Leonard
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
5
|
Shay AD, Zaniletti I, Davis KP, Bolin E, Richter GT. Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database. Laryngoscope 2022; 133:1228-1233. [PMID: 35796305 DOI: 10.1002/lary.30274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize pediatric bilateral vocal fold dysfunction and to examine the overall inpatient mortality. METHODS Retrospective cohort analysis. Data from the Pediatric Health Information System was gathered for all pediatric patients with a diagnosis of bilateral vocal fold dysfunction between January 2008 and September 2020. Univariate and multivariate analyses were performed using Cox proportional hazard models. RESULTS 2395 patients accounted for 4799 hospitalizations with bilateral vocal fold dysfunction. Inpatient mortality occurred in 2.9% of the study sample. Chiari 2 was found in 2.8% of patients. The most common associated diagnoses were related to comorbid respiratory conditions (61.1%). The median adjusted ratio of cost to charges was $76,569. Aspiration was noted in 28 patients (1.2%). Gastrostomy was performed in 607 patients (25.3%). Tracheostomy was performed in 27% of patients. The overall 90-day readmission rate was 61%. On multivariate analysis, prognostic factors associated with increased hospital survival include gastrointestinal comorbidities (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.18-0.49) and tracheostomy (HR: 0.21; 95% CI: 0.12-0.37). CONCLUSION This database study represents the largest cohort analysis to date characterizing bilateral vocal fold dysfunction. Favorable prognostic indicators of overall hospital survival include gastrointestinal comorbidities and the presence of tracheostomy. Tracheostomy is associated with an increase in hospital costs, comorbidities, gastrostomy tube placement, and Chiari diagnosis. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
Collapse
Affiliation(s)
- Aryan D Shay
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | | | - Kyle P Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| | - Elijah Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas, U.S.A
| | - Gresham T Richter
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A
| |
Collapse
|
6
|
Gupta A, Damania RC, Talati R, O'Riordan MA, Matloub YH, Ahuja SP. Increased Toxicity Among Adolescents and Young Adults Compared with Children Hospitalized with Acute Lymphoblastic Leukemia at Children's Hospitals in the United States. J Adolesc Young Adult Oncol 2021; 10:645-653. [PMID: 33512257 DOI: 10.1089/jayao.2020.0154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) patients (15-39 years old) with acute lymphoblastic leukemia (ALL) have less favorable outcomes and higher treatment-related mortality as compared with older children with ALL. Minimal data exist regarding how well AYA patients tolerate the intensity of chemotherapy at doses and regimens designed for children, and the toxicities suffered by this population at children's hospitals have not been thoroughly characterized. Methods: Pediatric Health Information Systems database was queried to analyze health care outcomes in pediatric (ages 10-14) and AYA patients (ages 15-39) with ALL hospitalized between January 1999 and December 2014. We extracted relevant ICD-9 data for each patient related to grades 3 or 4 toxicities as outlined by the NCI. Results: A total of 5345 hospital admissions met inclusion criteria, representing 4046 unique patients. Of these admissions, 2195 (41.1%) were in the AYA age group, and the remainder were in the 10-14-year-old group. AYA patients had a significantly higher incidence of intensive care unit stay but no difference in median hospital stay nor mortality. AYA patients had increased toxicities in almost every organ system as compared with older children. Conclusions: In this large multicenter US database study, we found an overall increased number of toxicities among AYA patients with ALL in children's hospitals. Compared with children between the ages of 10 and 15, AYA patients developed disproportionately higher toxicities from drugs commonly used in pediatric protocols for ALL. Prospective studies are needed to assess whether dose modifications for certain chemotherapeutics may improve the toxicity profile and health care burden of AYA patients with ALL treated in children's hospitals.
Collapse
Affiliation(s)
- Ajay Gupta
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Rahul C Damania
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ravi Talati
- Division of Hematology, Oncology, and Blood and Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mary Ann O'Riordan
- Women's & Children's Services, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Yousif H Matloub
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjay P Ahuja
- Division of Pediatric Hematology/Oncology, Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Derderian SC, Meier M, Partrick DA, Demasellis G, Reiter PD, Annam A, Bruny J. Pediatric empyemas - Has the pendulum swung too far? J Pediatr Surg 2020; 55:2356-61. [PMID: 31973927 DOI: 10.1016/j.jpedsurg.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The management of childhood empyemas has transformed over the past decade, with current trends favoring chest tube placement and intrapleural fibrinolytic therapy. Although this strategy often avoids the need for video-assisted thoracoscopic surgery (VATS), hospital length of stay can be long. METHODS To characterize national trends and outcomes associated with empyema management, the Pediatric Health Information System (PHIS) database was queried to identify children (2 months-18 years) treated for an empyema between January 2010 and December 2017. The cohort was divided into those treated with primary VATS and those treated with chest tube and intrapleural fibrinolysis. Number of chest radiographic studies obtained, frequency of pediatric intensive care unit (PICU) admission, mechanical ventilation requirements, and length of hospitalization were compared between groups. RESULTS A total of 3,365 otherwise healthy children met inclusion criteria. Among them, 523 (16%) were managed with primary VATS and 2,842 (84%) were managed with chest tube and fibrinolytic therapy. Of those who were treated with chest tube and fibrinolysis, 193 (6.8%) subsequently underwent VATS. The percentage of children treated with chest tube and fibrinolysis increased from 65% in 2010 to 95% in 2017 (p<0.001). After adjusting for age, race, ethnicity, payer, and region, children who underwent primary VATS received fewer chest radiographic studies, were less likely to be admitted to the PICU or require mechanical ventilation and had a shorter PICU and hospital length of stay compared to those who were treated with chest tube and fibrinolytic therapy (p<0.001 for all analyses). DISCUSSION Although national trends favor chest tube and fibrinolysis, primary VATS are associated with a shorter hospital and PICU length of stay and a lower requirement for mechanical ventilation. Future studies should aim to risk stratify children who may suffer from a protracted course with the goal to offer primary VATS to this subset of children and return them to normal life more expeditiously. LEVEL OF EVIDENCE III.
Collapse
|
8
|
Mahan ST, Kalish LA, Shah AS, Feldman L, Bae DS. Institutional Variation in Surgical Rates and Costs for Pediatric Distal Radius Fractures: Analysis of the Pediatric Health Information System ( PHIS) Database. Iowa Orthop J 2020; 40:75-81. [PMID: 32742212 PMCID: PMC7368512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Reduction of variations may streamline healthcare delivery, improve patient outcomes, and minimize cost. The purpose of this study was to characterize variations in surgical rates and hospital costs for treatment of pediatric distal radius fractures (DRFs) using Pediatric Health Information System (PHIS) database. METHODS The PHIS database was queried from 2009-2013 for DRFs in patients 4-18 years of age. Patients who underwent surgical treatment with internal fixation were identified using surgical CPT codes and/or ICD-9 procedure codes. 25 children's hospitals were included. Surgical rates and hospital costs were modeled. Rates were adjusted and standardized for gender, age, presence of other diagnoses, and year. RESULTS The aggregate rate of surgery for treatment of DRF was 2.65% and for open surgery was 0.81%. The standardized surgical rates for the 25 hospitals ranged widely, from 1.45% to 13.8% and for open surgical treatment from 0.51% to 4.27%. Six of the 25 hospitals had rates significantly higher than the aggregate for surgical treatment. Standardized hospital costs per patient ranged from $361 to $1,088 (2013 US dollars) across the hospitals with fairly uniform distribution. CONCLUSIONS In the United States, there is great variability in practice and hospital costs of treatment of distal radius fractures. Further characterization of the root causes of these variations, and the effect, if any, on patient outcomes, is needed to improve value delivery in pediatric orthopaedic care.Level of Evidence: II.
Collapse
Affiliation(s)
- Susan T. Mahan
- Boston Children’s Hospital, Department of Orthopaedics, Boston, MA
| | - Leslie A. Kalish
- Boston Children’s Hospital, Institutuional Centers for Clinic and Translational Research
| | - Apurva S. Shah
- Childrens Hospital of Philadelphia, Division of Orthopaedics
| | - Lanna Feldman
- Boston Children’s Hospital, Department of Orthopaedics, Boston, MA
| | - Donald S. Bae
- Boston Children’s Hospital, Department of Orthopaedics, Boston, MA
| |
Collapse
|
9
|
Balch A, Wilkes J, Thorell E, Pavia A, Sherwin CMT, Enioutina EY. Changing trends in IVIG use in pediatric patients: A retrospective review of practices in a network of major USA pediatric hospitals. Int Immunopharmacol 2019; 76:105868. [PMID: 31487613 DOI: 10.1016/j.intimp.2019.105868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 01/19/2023]
Abstract
The use of immunoglobulins is gradually increasing. Intravenous immunoglobulins (IVIG) are used as replacement therapy for primary and secondary immune deficiencies, and as an anti-inflammatory and immunomodulatory medication for the treatment of neurologic, dermatologic, and rheumatologic diseases. The objective of this study was to analyze trends in the IVIG use in pediatric patients hospitalized to 47 US-based children's hospitals from 2007 to 2014. IVIG was used for the treatment of >2300 primary diagnoses in 53,648 unique patients. The number of IVIG admissions increased by 30.2% during the study period, while the mean rate of IVIG admissions/100,000 admissions increased only 5.8%. Most patients receiving IVIG were children and adolescents. IVIG was frequently used off-label or for the treatment of FDA-approved indications in children under two years of age and BMT patients <20 years of age. Primary immune deficiencies represented only 1.2% of all IVIG admissions. Pediatric patients with mucocutaneous lymph node syndrome (Kawasaki disease, KD) and idiopathic thrombocytopenic purpura (ITP) were two primary consumers of the IVIG. Another top-ranked indications were acute infectious polyneuritis (Guillain-Barré syndrome, GBS) and prophylaxis of infections in patients receiving antineoplastic chemotherapy. IVIG usage is a dynamic process guided by emerging evidence and FDA approval for new indications. IVIG was mostly prescribed for treatment of diseases with pathologic immune responses to foreign of self-antigens. These indications usually, require higher amounts of IVIG per admission. More studies are needed to understand whether IVIG treatments of off-label indications are effective and cost-efficient.
Collapse
Affiliation(s)
- Alfred Balch
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Wilkes
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Emily Thorell
- Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrew Pavia
- Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Catherine M T Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| |
Collapse
|
10
|
Corkum KS, Baumann LM, Lautz TB. Complication Rates for Pediatric Hepatectomy and Nephrectomy: A Comparison of NSQIP-P, PHIS, and KID. J Surg Res 2019; 240:182-190. [PMID: 30954859 DOI: 10.1016/j.jss.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/22/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Three large national data sets are commonly used to assess operative outcomes in pediatric surgery; National Surgical Quality Improvement Program Pediatric (NSQIP-P), Pediatric Health Information System (PHIS), and Kids' Inpatient Data set (KID). Hepatectomy and nephrectomy are rare pediatric surgical procedures, which may benefit from large administrative data sets for the assessment of short-term complications. MATERIALS AND METHODS A retrospective review of NSQIP-P (2012-2015), KID (2012), and PHIS (2012-2015) was performed for hepatectomy or nephrectomy cases for children aged 0 to 18 y. Thirty-day perioperative outcomes were collected, analyzed, and compared across data sets and surgical cohorts. RESULTS Rates of surgical site infection, wound dehiscence, central line infection, sepsis, and venous thromboembolism were similar across NSQIP-P, PHIS, and KID in both cohorts. Rates of pneumonia and renal insufficiency were higher in PHIS and KID versus NSQIP-P in both cohorts. Blood transfusions in NSQIP-P were higher than PHIS and KID in the hepatectomy group (50.9% versus 43.0% versus 32.4%, P < 0.001), but similar across data sets in the nephrectomy cohorts (12.0% versus 14.0% versus 13.0%, P = 0.15). PHIS reported higher readmission rates than NSQIP-P for both the hepatectomy (56.5% versus 17.9%, P < 0.001) and nephrectomy (32.6% versus 7.6%,P < 0.001) cohorts. Thirty-day mortality rates were similar between NSQIP-P and PHIS, but higher in KID as compared with NSQIP-P for hepatectomy (6.4% versus 0.4%, P < 0.001) and nephrectomy (2.0% versus 0.3%, P < 0.001) cases. CONCLUSIONS Administrative data sets provide large sample sizes for the study of low-volume procedures in children, but there are significant variations in the reported rates of perioperative outcomes between NSQIP-P, PHIS, and KID. Therefore, surgical outcomes should be interpreted within the context of the strengths and limitations of each data set.
Collapse
Affiliation(s)
- Kristine S Corkum
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren M Baumann
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Timothy B Lautz
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| |
Collapse
|
11
|
Wang A, Prieto JM, Ward E, Bickler S, Henry M, Kling K, Thangarajah H, Ignacio R. Operative treatment for intussusception: Should an incidental appendectomy be performed? J Pediatr Surg 2019; 54:495-499. [PMID: 30583859 DOI: 10.1016/j.jpedsurg.2018.10.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES An incidental appendectomy is performed by some surgeons during operative treatment for intussusception to eliminate future appendicitis as a diagnostic consideration. However, an appendectomy can increase the risk of infection and other noninfectious complications making an incidental appendectomy controversial. We examined outcomes for surgical intervention for intussusception with appendectomy (SWA) compared to surgical reduction alone (SRA). METHODS The Pediatric Health Information System database, 8/2008-9/2015, was retrospectively analyzed for patients under the age of five who required an operative intervention for intussusception without bowel resection. Demographic data and postoperative outcomes were analyzed. Available data included need for postoperative enema, subsequent small bowel obstruction, recurrent intussusception, length of stay (LOS), and adjusted total cost (ATC). RESULTS Fifty-seven percent (748/1312) of patients had appendectomy performed during surgical reduction, 564 (43%) did not. ATC ($10,594 vs. $8939, p < 0.001) and LOS (3.0 vs. 2.48, p < 0.001) are higher in the SWA group. Rates of readmission are similar, but post-operative small bowel obstruction may be higher in the SWA group (1.3% vs. 0.35%, p = 0.06). CONCLUSION There is a higher mean LOS and ATC in the SWA group. This study suggests that appendectomy during surgery for uncomplicated intussusception should be reconsidered and requires further investigation. TYPE OF STUDY retrospective comparative study. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Andrew Wang
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - James M Prieto
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Erin Ward
- Department of Surgery, School of Medicine, University of California, La Jolla, CA 92093, USA
| | - Stephen Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA 92123, USA
| | - Marion Henry
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Karen Kling
- Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA 92123, USA
| | | | - Romeo Ignacio
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA.
| |
Collapse
|
12
|
Workman JK, Wilkes J, Presson AP, Xu Y, Heflin JA, Smith JT. Variation in Adolescent Idiopathic Scoliosis Surgery: Implications for Improving Healthcare Value. J Pediatr 2018; 195:213-219.e3. [PMID: 29426688 DOI: 10.1016/j.jpeds.2017.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/20/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To investigate the variation in care and cost of spinal fusion for adolescent idiopathic scoliosis (AIS), and to identify opportunities for improving healthcare value. STUDY DESIGN Retrospective cohort study from the Pediatric Health Information Systems database, including children 11-18 years of age with AIS who underwent spinal fusion surgery between 2004 and 2015. Multivariable regression was used to evaluate the relationships between hospital cost, patient outcomes, and resource use. RESULTS There were 16 992 cases of AIS surgery identified. There was marked variation across hospitals in rates of intensive care unit admission (0.5%-99.2%), blood transfusions (0%-100%), surgical complications (1.8%-32.3%), and total hospital costs ($31 278-$90 379). Hospital cost was 32% higher at hospitals that most frequently admitted patients to the intensive care unit (P = .009), and 8% higher for each additional 25 operative cases per hospital (P = .003). Hospital duration of stay was shorter for patients admitted to hospitals with highest intensive care unit admission rates and higher surgical volumes. There was no association between cost and duration of stay, 30-day readmission, or surgical complications. The largest contribution to hospital charges was supplies (55%). Review of a single hospital's detailed cost accounting system also found supplies to be the greatest single contributor to cost, the majority of which were for spinal implants, accounting for 39% of total hospital costs. CONCLUSIONS The greatest contribution to AIS surgery cost was supplies, the majority of which is likely attributed to spinal implant costs. Opportunities for improving healthcare value should focus on controlling costs of spinal instrumentation, and improving quality of care with standardized treatment protocols.
Collapse
Affiliation(s)
- Jennifer K Workman
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jacob Wilkes
- Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, UT
| | - Angela P Presson
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Yizhe Xu
- Division of Epidemiology, Department of Population Health Science, University of Utah, Salt Lake City, UT
| | - John A Heflin
- Department of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - John T Smith
- Department of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
13
|
Jones L, Koch T, Stanek J, O'Brien SH. Patterns of Emergency Department Care for Newly Diagnosed Immune Thrombocytopenia in United States Children's Hospitals. J Pediatr 2017; 190:265-267. [PMID: 28734656 DOI: 10.1016/j.jpeds.2017.06.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/19/2017] [Accepted: 06/21/2017] [Indexed: 11/27/2022]
Abstract
We used the Pediatric Health Information Systems database to ascertain treatment patterns of immune thrombocytopenia across the US. Despite the recently published guidelines by the American Society of Hematology, most patients are still being hospitalized for immune thrombocytopenia, even in the absence of documented bleeding symptoms.
Collapse
Affiliation(s)
- LaQuita Jones
- Pediatric Residency Program, Nationwide Children's Hospital, Columbus, OH
| | - Terah Koch
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH
| | - Sarah H O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH.
| |
Collapse
|
14
|
Thompson RM, Thurm CW, Rothstein DH. Interhospital Variability in Perioperative Red Blood Cell Ordering Patterns in United States Pediatric Surgical Patients. J Pediatr 2016; 177:244-249.e5. [PMID: 27453372 DOI: 10.1016/j.jpeds.2016.06.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals. STUDY DESIGN This is a multicenter cross-sectional study of children aged <19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability. Orders for blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient. RESULTS A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25). CONCLUSIONS The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood.
Collapse
Affiliation(s)
- Rachel M Thompson
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX
| | - Cary W Thurm
- Children's Hospital Association, Overland Park, KS
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
| |
Collapse
|
15
|
Han MJ, Xiong CL, Zhang HB, Zhang MQ, Zhang HH, Zhang Z. The diversification of PHIS transposon superfamily in eukaryotes. Mob DNA 2015; 6:12. [PMID: 26120370 PMCID: PMC4482050 DOI: 10.1186/s13100-015-0043-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PHIS transposon superfamily belongs to DNA transposons and includes PIF/Harbinger, ISL2EU, and Spy transposon groups. These three groups have similar DDE domain-containing transposases; however, their coding capacity, species distribution, and target site duplications (TSDs) are significantly different. RESULTS In this study, we systematically identified and analyzed PHIS transposons in 836 sequenced eukaryotic genomes using transposase homology search and structure approach. In total, 380 PHIS families were identified in 112 genomes and 168 of 380 families were firstly reported in this study. Besides previous identified PIF/Harbinger, ISL2EU, and Spy groups, three new types (called Pangu, NuwaI, and NuwaII) of PHIS superfamily were identified; each has its own distinctive characteristics, especially in TSDs. Pangu and NuwaII transposons are characterized by 5'-ANT-3' and 5'-C|TNA|G-3' TSDs, respectively. Both transposons are widely distributed in plants, fungi, and animals; the NuwaI transposons are characterized by 5'-CWG-3' TSDs and mainly distributed in animals. CONCLUSIONS Here, in total, 380 PHIS families were identified in eukaryotes. Among these 380 families, 168 were firstly reported in this study. Furthermore, three new types of PHIS superfamily were identified. Our results not only enrich the transposon diversity but also have extensive significance for improving genome sequence assembly and annotation of higher organisms.
Collapse
Affiliation(s)
- Min-Jin Han
- School of Life Sciences, Chongqing University, Chongqing, 400044 China
| | - Chu-Lin Xiong
- School of Life Sciences, Chongqing University, Chongqing, 400044 China
| | - Hong-Bo Zhang
- School of Life Sciences, Chongqing University, Chongqing, 400044 China
| | - Meng-Qiang Zhang
- School of Life Sciences, Chongqing University, Chongqing, 400044 China
| | - Hua-Hao Zhang
- College of Pharmacy and Life Science, Jiujiang University, Jiujiang, 332000 China
| | - Ze Zhang
- School of Life Sciences, Chongqing University, Chongqing, 400044 China
| |
Collapse
|
16
|
Virgin FW, Huang L, Roberson DW, Sawicki GS. Inter-hospital variation in the frequency of sinus surgery in children with cystic fibrosis. Pediatr Pulmonol 2015; 50:231-235. [PMID: 24700651 DOI: 10.1002/ppul.23046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 03/04/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic rhinosinusitis and nasal polyposis are common conditions in cystic fibrosis (CF). Approximately 2-3% of pediatric CF patients per year have sinus disease requiring surgery. The purpose of this study was to evaluate the variation of sinus surgery rates in pediatric CF patients across multiple US pediatric hospitals. METHODS The Pediatric Health Information System (PHIS) compiles inpatient administrative data from 42 pediatric hospitals. We conducted a retrospective analysis of PHIS for the period January 1, 2008 to January 1, 2011 to evaluate frequency of sinus surgery at each hospital. We identified CF patients and sinus surgery during inpatient encounters using ICD-9 codes. Demographic data and data for each hospital on hospital size, number of pediatric otolaryngologists, average FEV1, and percentage of patients meeting minimum care guidelines were collected. Twenty-nine hospitals were included in analysis using mixed-effects logistic regression models for occurrence of sinus surgery. RESULTS We identified 5,194 CF patients, accounting for 18,788 unique encounters among 29 hospitals. 880 patients underwent 1,397 sinus operations. Total number of CF patients at each institution ranged from 39 to 364 and total number of sinus surgeries ranged from 4 to 205, over the 3-year period. Variation in the rate of sinus surgery with hospital encounter was observed (1-24%). Hospital-average lung function (P = 0.56), number of otolaryngologists (P = 0.65) were not found to be predictors of sinus surgery. The size of the CF center (P = 0.01), hospital size (P = 0.05), and age at admission (P ≤ 0.0001) were associated with an increased frequency of sinus surgery. However, with multivariable analysis, only size of the CF center and age of admission remained statistically significant predictors of surgery with admission. CONCLUSIONS There is large variation in the incidence of sinus surgery for CF in 29 of the largest freestanding pediatric hospitals. This study highlights remarkable variation in clinical practice and underscores the need for further research into the indications and benefits of sinus surgery in pediatric patients with CF. Pediatr Pulmonol. 2015; 50:231-235. © 2014 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Frank W Virgin
- Division Pediatric Otolaryngology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Lin Huang
- Department of Biostatistics, Children's Hospital Boston, Boston, Massachusetts
| | - David W Roberson
- Department of Otolarynogolgy, Department of Otology and Laryngology Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Children's Hospital Boston, Boston, Massachusetts
| |
Collapse
|
17
|
Sulkowski JP, Cooper JN, Duggan EM, Balci O, Anandalwar SP, Blakely ML, Heiss K, Rangel S, Minneci PC, Deans KJ. Does timing of neonatal inguinal hernia repair affect outcomes? J Pediatr Surg 2015; 50:171-6. [PMID: 25598118 PMCID: PMC4298703 DOI: 10.1016/j.jpedsurg.2014.10.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to examine practice variability and compare outcomes between early and delayed neonatal inguinal hernia repair (IHR). METHODS Patients admitted to neonatal intensive care units with a diagnosis of IH who underwent IHR by age 1 year in the Pediatric Health Information System from 1999 to 2011 were included. IHR after the index hospitalization was considered delayed. Inter-hospital variability in the proportion of delayed repairs and differences in outcomes for each group were compared. A propensity score matched analysis was performed to account for baseline differences between treatment groups. RESULTS Of the 2030 patients identified, 32.9% underwent delayed IHR with significant variability in the proportion of patients having delayed repair across hospitals (p<0.0001). More patients in the delayed group had a congenital anomaly or received life supportive measures prior to IHR (all p<0.01), and 8.2% of patients undergoing delayed repair had a diagnosis of incarceration at repair. More patients in the early group underwent reoperation for hernia within 1 year (5.9% vs. 3.7%, p=0.02). Results were similar after performing a propensity score matched analysis. CONCLUSIONS Significant variability in practice exists between children's hospitals in the timing of IHR, with delayed repair associated with incarceration and early repair with a higher rate of reoperation.
Collapse
Affiliation(s)
- Jason P Sulkowski
- Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Eileen M Duggan
- Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital, Nashville, TN
| | - Ozlem Balci
- Department of Pediatric Surgery, Children's Hospital of Atlanta, Atlanta, GA
| | | | - Martin L Blakely
- Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital, Nashville, TN
| | - Kurt Heiss
- Department of Pediatric Surgery, Children's Hospital of Atlanta, Atlanta, GA
| | - Shawn Rangel
- Department of Pediatric Surgery, Children's Hospital Boston, Boston, MA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Department of Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.
| |
Collapse
|
18
|
Sulkowski JP, Cooper JN, McConnell PI, Pasquali SK, Shah SS, Minneci PC, Deans KJ. Variability in noncardiac surgical procedures in children with congenital heart disease. J Pediatr Surg 2014; 49:1564-9. [PMID: 25475794 PMCID: PMC4259048 DOI: 10.1016/j.jpedsurg.2014.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine the volume and variability of noncardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. METHODS Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004 and 2012 were included. Frequencies of noncardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a noncardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. RESULTS 8857 patients underwent congenital heart surgery during the first year of life, 3621 (41%) of whom had 13,894 noncardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4432; 31.9%) or otolaryngology (4002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having noncardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1-3), children in the high-risk group (categories 4-6) were more likely to have general, dental, orthopedic, and thoracic procedures. CONCLUSIONS Children with CHD requiring cardiac surgery frequently also undergo noncardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population.
Collapse
Affiliation(s)
- Jason P. Sulkowski
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer N. Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Patrick I. McConnell
- Division of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Sara K. Pasquali
- Division of Cardiology, Department of Pediatrics, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, MI
| | - Samir S. Shah
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Peter C. Minneci
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Katherine J. Deans
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| |
Collapse
|
19
|
Sulkowski JP, Cooper JN, Congeni A, Pearson EG, Nwomeh BC, Doolin EJ, Blakely ML, Minneci PC, Deans KJ. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619-25. [PMID: 25475806 PMCID: PMC4257999 DOI: 10.1016/j.jpedsurg.2014.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 04/22/2014] [Accepted: 06/03/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate surgical treatments and outcomes in a multi-institutional cohort of neonates with Hirschsprung's disease (HD). METHODS Using the Pediatric Health Information System (PHIS) from 1999 to 2009, neonates diagnosed with HD were identified and classified as having a single stage pull-through (SSPT) or multi-stage pull-through (MSPT). Diagnosis and classification algorithms and clinical variables and outcomes were validated by multi-institutional chart review. Groups were compared using logistic regression modeling and propensity-score matched analysis to account for baseline differences between groups. RESULTS 1555 neonates with HD were identified; 77.2% underwent SSPT and 22.8% underwent MSPT. Misclassification of disease or surgical treatment was <2%. Rates of SSPT increased over time (p=0.03). Compared to SSPT, patients undergoing MSPT had significantly lower birth weights and higher rates of prematurity, non-HD gastrointestinal anomalies, enterocolitis, and preoperative mechanical ventilation. Patients undergoing MSPT had significantly higher rates of readmissions (58.5 vs. 37.9%) and additional operations (38.7 vs. 26%). Results were consistent in the propensity-score matched analysis. CONCLUSION Most neonates with HD undergo SSPT. In patients with similar observed baseline characteristics, MSPT was associated with worse outcomes suggesting that some infants currently selected to undergo MSPT may have better outcomes with SSPT. However, there remains a subgroup of MSPT patients who were too ill to be adequately compared to SSPT patients; for this subgroup of severely ill infants with HD, MSPT may be the best option.
Collapse
Affiliation(s)
- Jason P. Sulkowski
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer N. Cooper
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Anthony Congeni
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Erik G. Pearson
- Department of Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Benedict C. Nwomeh
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Edward J. Doolin
- Department of Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Martin L. Blakely
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Peter C. Minneci
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Katherine J. Deans
- Center for Surgical Outcomes Research and Department of Surgery, Nationwide Children’s Hospital, Columbus, OH
| |
Collapse
|
20
|
Sulkowski JP, Asti L, Cooper JN, Kenney BD, Raval MV, Rangel SJ, Deans KJ, Minneci PC. Morbidity of peripherally inserted central catheters in pediatric complicated appendicitis. J Surg Res 2014; 190:235-41. [PMID: 24721604 DOI: 10.1016/j.jss.2014.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND The purpose of this study was to compare postoperative outcomes of pediatric patients with complicated appendicitis managed with or without a peripherally inserted central catheter (PICC). METHODS Patients aged ≤18 y in the Pediatric Health Information System database with complicated appendicitis that underwent appendectomy during their index admission in 2000-2012 were grouped by whether they had a PICC placed using relevant procedure and billing codes. Rates of subsequent encounters within 30 d of discharge along with associated diagnoses and procedures were determined. A propensity score-matched (PSM) analysis was performed to account for differences in baseline exposures and severity of illness. RESULTS We included 33,482 patients with complicated appendicitis; of whom, 6620 (19.8%) received a PICC and 26,862 (80.2%) did not. The PICC group had a longer postoperative length of stay (median 7 versus 5 d, P<0.001) and were more likely to undergo intra-abdominal abscess drainage during the index admission (14.4% versus 2.1%, P<0.001), and have a reencounter (17.5% versus 11.4%, P<0.001) within 30 d of discharge. However, in the PSM cohort (n=4428 in each group), outcomes did not differ between treatment groups, although the PICC group did have increased odds for the development of other postoperative complications (odds ratio=3.95, 95% confidence interval: 1.45, 10.71). CONCLUSIONS After accounting for differences in severity of illness by PSM, patients managed with PICCs had a similar risk for nearly all postoperative complications, including reencounters. Postoperative management of pediatric complicated appendicitis with a PICC is not clearly associated with improved outcomes.
Collapse
Affiliation(s)
- Jason P Sulkowski
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Lindsey Asti
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer N Cooper
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Brian D Kenney
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Mehul V Raval
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn J Rangel
- Department of Surgery, Children's Hospital Boston, Boston, Massachusetts
| | - Katherine J Deans
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Peter C Minneci
- Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
| |
Collapse
|
21
|
Kenyon CC, Melvin PR, Chiang VW, Elliott MN, Schuster MA, Berry JG. Rehospitalization for childhood asthma: timing, variation, and opportunities for intervention. J Pediatr 2014; 164:300-5. [PMID: 24238863 DOI: 10.1016/j.jpeds.2013.10.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/04/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals. STUDY DESIGN Retrospective cohort analysis of 44,204 hospitalizations for children with asthma within 42 children's hospitals between July 2008 and June 2011. The main outcome measures were rehospitalization for asthma within 7, 15, 30, 60, 180, and 365 days of an index asthma admission. RESULTS The rate of asthma rehospitalization ranged from 0.5% (n = 208) at 7 days to 17.2% (n = 7603) at 365 days. Black patients and patients with public insurance had higher odds of rehospitalization at 60 days and beyond (P ≤ .01 for both). Adolescents (12- to 18-year-old), patients with a diagnosis of a complex chronic condition, and patients with a prior year asthma admission had higher odds of rehospitalization at every time interval (P ≤ .001 for all). Significant hospital variation in case-mix adjusted rates of rehospitalization existed at each time interval (P ≤ .01 for all). Rates at 365 days were ≤ 10.9% for the top 10% of hospitals; if all hospitals achieved this rate, 36.6% of rehospitalizations might have been avoided. CONCLUSIONS Significant variation in asthma rehospitalization rates exists across children's hospitals from 7 to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By 1 year, rehospitalizations account for 1 in 6 hospitalizations. Assessing asthma rehospitalizations at longer intervals may augment our current understanding of and approach to post-hospitalization care improvement.
Collapse
|
22
|
Deans KJ, Cooper JN, Rangel SJ, Raval MV, Minneci PC, Moss RL. Enhancing NSQIP-Pediatric through integration with the Pediatric Health Information System. J Pediatr Surg 2014; 49:207-12; discussion 212. [PMID: 24439611 DOI: 10.1016/j.jpedsurg.2013.09.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE We implemented and validated a linkage algorithm for cases in both the National Surgical Quality Improvement Program-Pediatric (NSQIP-Peds) and the Pediatric Health Information System (PHIS) to investigate healthcare utilization during the first post-operative year. METHODS NSQIP-Peds and PHIS cases from our institution who were operated on between January 2010 and September 2011 were matched on gender and dates of birth, admission, and discharge. Rates of true matches were validated using medical records. We examined rates of emergency department (ED) visits, hospital readmissions, potentially preventable readmissions (PPR), and hospital charges within one year of the NSQIP-Peds encounter. RESULTS Of the 2,409 NSQIP-Peds and 61,147 PHIS records, 93.6% met match criteria with 92.5% being true matches. Post-operative ED visit rates were 7.8% within 30days, 17.2% between 31-180days, and 18.1% between 181-365days. Readmission rates were 5.5% within 30days, 9.3% between 31-180days, and 8.4% between 181-365days. In patients undergoing inpatient procedures, 10.6% had readmissions within 30days, and 23.7% had readmissions within 365days that were potentially preventable. CONCLUSIONS Using indirect identifiers, a linked NSQIP-Peds-PHIS dataset demonstrated high rates of ED visits, readmissions, and PPR in the first post-operative year. This dataset may provide a more comprehensive way to study health care utilization and clinical outcomes.
Collapse
Affiliation(s)
- Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Shawn J Rangel
- Department of Surgery, Children's Hospital Boston, Boston, MA, USA
| | - Mehul V Raval
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - R Lawrence Moss
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
23
|
Parnell AS, Shults J, Gaynor JW, Leonard MB, Dai D, Feudtner C. Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery. Ann Thorac Surg 2013; 97:641-50. [PMID: 24200398 DOI: 10.1016/j.athoracsur.2013.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 08/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. METHODS We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. RESULTS Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (p<0.001 for each procedure). Similarly, use of extracorporeal membrane oxygenation was highly associated with misclassification of CHS patients into a noncardiac APR-DRG (p<0.001 for each procedure). Cases misclassified into a noncardiac APR-DRG experienced a significantly increased mortality (p<0.001). CONCLUSIONS In classifying patients undergoing CHS, APR-DRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality.
Collapse
Affiliation(s)
- Aimee S Parnell
- Department of Pediatrics, Children's Healthcare of Mississippi, University of Mississippi School of Medicine, Jackson, Mississippi.
| | - Justine Shults
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - J William Gaynor
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary B Leonard
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
24
|
Wong TE, Huang YS, Weiser J, Brogan TV, Shah SS, Witmer CM. Antithrombin concentrate use in children: a multicenter cohort study. J Pediatr 2013; 163:1329-34.e1. [PMID: 23932317 PMCID: PMC3812320 DOI: 10.1016/j.jpeds.2013.06.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/24/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the off-label use of antithrombin concentrate in tertiary care pediatric hospitals across the US. STUDY DESIGN This is a retrospective, multicenter, cohort study of 4210 admissions of children younger than 18 years of age who received antithrombin concentrate between 2002 and 2011 within the Pediatric Health Information System administrative database. An on-label admission was defined as an admission with an International Classification of Diseases diagnostic code for a primary hypercoagulable state; admissions without this code were classified as off-label. RESULTS During the 10-year study period, off-label use of antithrombin concentrate increased 5-fold. Overall, 97% of study subjects received antithrombin off-label. Neonates younger than 30 days of age comprised the largest age group (45.7%) of use; 87% of patients had at least one complex chronic condition, with congenital heart/lung defects being the most prevalent primary diagnosis (36.3%). Extracorporeal membrane oxygenation was the most common procedure associated with antithrombin use (43.7%). CONCLUSIONS The off-label use of antithrombin concentrate is increasing rapidly, particularly in critically ill children receiving extracorporeal membrane oxygenation, with few parallel studies to substantiate its safety or efficacy. Further preclinical and controlled clinical studies are critical to expanding our knowledge of this drug. In the meantime, antithrombin concentrate should be used judiciously by clinicians and following guidelines instated by hospitals.
Collapse
Affiliation(s)
- Trisha E. Wong
- Puget Sound Blood Center, Seattle, WA,Division of Hematology/Oncology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Yuan-Shung Huang
- Division of General Pediatrics, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jason Weiser
- Division of Hospital Medicine, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH
| | - Thomas V. Brogan
- Division of Critical Care, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Samir S. Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH,Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Char M. Witmer
- Division of Hematology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| |
Collapse
|
25
|
Sulkowski JP, Deans KJ, Asti L, Mattei P, Minneci PC. Using the Pediatric Health Information System to study rare congenital pediatric surgical diseases: development of a cohort of esophageal atresia patients. J Pediatr Surg 2013; 48:1850-5. [PMID: 24074656 DOI: 10.1016/j.jpedsurg.2013.02.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 02/16/2013] [Accepted: 02/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND/PURPOSE Administrative databases include large multi-institutional cohorts of patients with rare congenital anomalies that can potentially be used to characterize these diseases and study variations in practice and outcomes. The purpose of this study was to develop a methodology to accurately identify a cohort of patients with a rare disease (esophageal atresia and tracheoesophageal fistula, EA/TEF) in the Pediatric Health Information System (PHIS) database. METHODS Patients with EA/TEF treated from 2001 to 2010 were identified by chart review at two institutions and then located within the PHIS database to find ICD-9-CM coding patterns unique to EA/TEF. Subsequently, a step-wise search strategy for PHIS was developed to identify patients with EA/TEF: this included searching the ICD-9-CM diagnosis code for congenital EA/TEF; adding the ICD-9-CM code for acquired TEF; limiting age to ≤ 30 days; and adding at least one of a number of specified ICD-9-CM procedure codes. The PHIS search results were subsequently validated by chart review at each institution. RESULTS The institutional chart reviews identified 207 patients with EA/TEF. The most refined PHIS search strategy identified 221 patients. The positive predictive value of the search increased incrementally from 65% with using only the correct ICD-9 code to 96% with the full methodology. A cohort of 2977 patients with EA/TEF is identified when this search strategy is applied to the entire PHIS database. CONCLUSION Administrative databases such as PHIS can be utilized to identify cohorts of patients with rare congenital anomalies; however, cohort development requires a systematic search strategy and validation process to ensure correct identification of patients.
Collapse
Affiliation(s)
- Jason P Sulkowski
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus OH, USA
| | | | | | | | | |
Collapse
|
26
|
de Blank P, Zaoutis T, Fisher B, Troxel A, Kim J, Aplenc R. Trends in Clostridium difficile infection and risk factors for hospital acquisition of Clostridium difficile among children with cancer. J Pediatr 2013; 163:699-705.e1. [PMID: 23477996 DOI: 10.1016/j.jpeds.2013.01.062] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/26/2012] [Accepted: 01/30/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To study the trend of Clostridium difficile infection (CDI) and risk factors for hospital acquired CDI (HA-CDI) among children with cancer. STUDY DESIGN We analyzed 33 095 first pediatric hospitalizations for malignancy among 43 pediatric hospitals between 1999 and 2011. The effect of demographics, disease characteristics, and weekly drug exposure (antibiotics, antacids, and chemotherapy) on HA-CDI was assessed with multivariate Cox regression. CDI was defined by the combination of International Classification of Diseases, 9th edition-Clinical Modification (ICD-9CM), CDI diagnostic assay billing code, and concurrent administration of a CDI-active antibiotic. HA-CDI was defined as CDI with assay occurring after the sixth hospital day. RESULTS A total of 1736 admissions with CDI were identified, of which 380 were HA-CDI. CDI incidence increased from 1999-2006 (P = .01); however, CDI testing frequency and disease decreased from 2006-2010 (P < .05). Admissions with HA-CDI had longer lengths of stay compared with those without HA-CDI (35 days vs 12 days, P < .01) and greater risk of inpatient mortality (relative risk 2.3, P < .01). Increased risk of HA-CDI (hazard ratio [95% CI]) was seen after exposure to the following drugs: aminoglycoside (1.357 [1.053-1.749]), third generation cephalosporin (1.518 [1.177-1.959]), cefepime (2.383 [1.839-3.089]), and proton pump inhibiting agent (1.398 [1.096-1.784]) in the prior week, and chemotherapy (1.942 [1.491-2.529]) in the 8-14 days prior to HA-CDI onset. Histamine-2 receptor antagonist exposure in the prior week was associated with decreased risk of HA-CDI (0.730 [0.584-0.912]). CONCLUSIONS Despite an apparent decrease in CDI incidence from 2006-2010, HA-CDI remains prevalent and morbid among children with cancer. Recent exposure to chemotherapy, proton pump inhibitor, and certain antibiotics were independent risk factors for HA-CDI.
Collapse
|
27
|
Thompson AJ, McSwain SD, Webb SA, Stroud MA, Streck CJ. Venous thromboembolism prophylaxis in the pediatric trauma population. J Pediatr Surg 2013; 48:1413-21. [PMID: 23845640 DOI: 10.1016/j.jpedsurg.2013.02.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 02/13/2013] [Accepted: 02/15/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to review evidence-based literature addressing pertinent questions about venous thromboembolism (VTE) after traumatic injury in children. METHODS Data were obtained from English-language articles identified through Pubmed published from 1995 until November 2012, and from bibliographies of relevant articles. Studies were included if they contributed evidence to one of the following questions. In the pediatric traumatic injury population: (1) What is the overall incidence of VTE? (2) Is age (adolescence versus pre-adolescence) associated with higher VTE incidence? (3) Which risk factors are associated with higher VTE incidence? (4) Does mechanical and/or pharmacological prophylaxis impact outcomes? RESULTS Eighteen articles were included in this systematic review. The evidence regarding each question was evaluated, graded by author consensus, and summarized. CONCLUSIONS The overall incidence of VTE is low. Older (>13years) and more severely injured patients are at higher VTE risk. Additional factors including injury type or presence of a central venous catheter also place a patient at higher VTE risk. Implementation of a risk-based clinical practice guideline for VTE prophylaxis has been associated with reduced symptomatic VTE at one institution. Randomized, prospective trials analyzing outcomes of VTE prophylaxis in pediatric trauma victims are needed.
Collapse
Affiliation(s)
- A Jill Thompson
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
| | | | | | | | | |
Collapse
|
28
|
Schlomer BJ, Saperston K, Baskin L. National trends in augmentation cystoplasty in the 2000s and factors associated with patient outcomes. J Urol 2013; 190:1352-7. [PMID: 23643599 DOI: 10.1016/j.juro.2013.04.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Augmentation cystoplasty is a major surgery performed by pediatric urologists. We evaluated national estimates of children undergoing augmentation cystoplasty in the United States for trends during the 2000s, and analyzed patient and hospital factors associated with outcomes. MATERIALS AND METHODS Patients who underwent augmentation cystoplasty registered in the 2000 to 2009 Kids' Inpatient Database were included. Estimates of total number of augmentation cystoplasties performed and patient and hospital characteristics were evaluated for trends. Hierarchical models were created to evaluate patient and hospital factors associated with length of stay, total hospital charges and odds of having a postoperative complication. RESULTS An estimated 792 augmentation cystoplasties were performed in 2000, which decreased to 595 in 2009 (p = 0.02). Length of stay decreased from 10.5 days in 2000 to 9.2 days in 2009 (p = 0.04). A total of 1,622 augmentation cystoplasties were included in the hierarchical models and 30% of patients had a complication identified. Patient factors associated with increased length of stay and increased odds of any complication included bladder exstrophy-epispadias complex diagnosis and older age. Pediatric hospitals had 31% greater total hospital charges (95% CI 7-55). CONCLUSIONS The estimated number of augmentation cystoplasties performed in children in the United States decreased by 25% in the 2000s, and mean length of stay decreased by 1 day. The cause of the decrease is multifactorial but could represent changing practice patterns in the United States. Of the patients 30% had a potential complication during hospitalization after augmentation cystoplasty. Older age and bladder exstrophy-epispadias complex diagnosis were associated with greater length of stay and increased odds of having any complication.
Collapse
Affiliation(s)
- Bruce J Schlomer
- Department of Urology, University of California San Francisco, San Francisco, California
| | | | | |
Collapse
|