Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications
Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the pr...
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| Veröffentlicht in: | Clinical gastroenterology and hepatology 2019-12, Vol.17 (13), p.2713-2721.e4 |
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| container_title | Clinical gastroenterology and hepatology |
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| creator | Egberg, Matthew D. Galanko, Joseph A. Kappelman, Michael D. |
| description | Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the proportion of colectomies performed at high-volume centers. We then evaluated the association between hospital colectomy volume and complications.
We performed a cross-sectional analysis of pediatric patients (age, ≤18 y) hospitalized for UC using the Kids’ Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5–0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions.
Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies ( |
| doi_str_mv | 10.1016/j.cgh.2019.03.003 |
| format | Article |
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We performed a cross-sectional analysis of pediatric patients (age, ≤18 y) hospitalized for UC using the Kids’ Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5–0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions.
Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (<5%) are performed at high-volume centers.</description><identifier>ISSN: 1542-3565</identifier><identifier>EISSN: 1542-7714</identifier><identifier>DOI: 10.1016/j.cgh.2019.03.003</identifier><identifier>PMID: 30853617</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; African Americans ; Child ; Child, Preschool ; Colectomy - statistics & numerical data ; Colectomy - trends ; Colitis, Ulcerative - surgery ; Cross-Sectional Studies ; Epidemiology ; European Continental Ancestry Group ; Female ; Guidelines ; Hispanic Americans ; Hospitals, High-Volume - statistics & numerical data ; Hospitals, Low-Volume - statistics & numerical data ; Humans ; IBD ; Ileus - epidemiology ; Insurance, Health - statistics & numerical data ; Logistic Models ; Male ; Medicaid - statistics & numerical data ; Multivariate Analysis ; Postoperative Complications - epidemiology ; Pulmonary Atelectasis - epidemiology ; Risk Factor ; Surgical Wound Infection - epidemiology ; United States - epidemiology</subject><ispartof>Clinical gastroenterology and hepatology, 2019-12, Vol.17 (13), p.2713-2721.e4</ispartof><rights>2019 AGA Institute</rights><rights>Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-d5f6ca433f7c225133360aa93b720c53e7d55c948c68be7882883110812500173</citedby><cites>FETCH-LOGICAL-c462t-d5f6ca433f7c225133360aa93b720c53e7d55c948c68be7882883110812500173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cgh.2019.03.003$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30853617$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Egberg, Matthew D.</creatorcontrib><creatorcontrib>Galanko, Joseph A.</creatorcontrib><creatorcontrib>Kappelman, Michael D.</creatorcontrib><title>Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications</title><title>Clinical gastroenterology and hepatology</title><addtitle>Clin Gastroenterol Hepatol</addtitle><description>Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the proportion of colectomies performed at high-volume centers. We then evaluated the association between hospital colectomy volume and complications.
We performed a cross-sectional analysis of pediatric patients (age, ≤18 y) hospitalized for UC using the Kids’ Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5–0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions.
Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (<5%) are performed at high-volume centers.</description><subject>Adolescent</subject><subject>African Americans</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Colectomy - statistics & numerical data</subject><subject>Colectomy - trends</subject><subject>Colitis, Ulcerative - surgery</subject><subject>Cross-Sectional Studies</subject><subject>Epidemiology</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Guidelines</subject><subject>Hispanic Americans</subject><subject>Hospitals, High-Volume - statistics & numerical data</subject><subject>Hospitals, Low-Volume - statistics & numerical data</subject><subject>Humans</subject><subject>IBD</subject><subject>Ileus - epidemiology</subject><subject>Insurance, Health - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicaid - statistics & numerical data</subject><subject>Multivariate Analysis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Pulmonary Atelectasis - epidemiology</subject><subject>Risk Factor</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>United States - epidemiology</subject><issn>1542-3565</issn><issn>1542-7714</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFOGzEQhq2qqFDgAXqpfOxlt2N7vfaKE4pKUylVORA4Wo53FhztxsF2qHh7HCX02NOMNN__S_MR8oVBzYC139e1e3yqObCuBlEDiA_kjMmGV0qx5uNxF7KVp-RzSmsA3jWd-kROBWgpWqbOSLi12eMmJ_rwFOhy02N8DHQWRnQ5TK90CJHeYu9tjt7R5egwlsAL7hGffaI200X4W92HcTchnYe09dmOic5tgX6HuCen7ehdiYVNuiAnQznj5XGek-XNj7vZvFr8-flrdr2oXNPyXPVyaJ1thBiU41wyIUQL1nZipTg4KVD1Urqu0a7VK1Rac60FY6AZlwBMiXPy7dC7jeF5hymbySeH42g3GHbJcNYBdExpUVB2QF0MKUUczDb6ycZXw8DsPZu1KZ7N3rMBYYrnkvl6rN-tJuz_Jd7FFuDqAGB58sVjNMkVz66ojEWt6YP_T_0bbj2NFA</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Egberg, Matthew D.</creator><creator>Galanko, Joseph A.</creator><creator>Kappelman, Michael D.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201912</creationdate><title>Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications</title><author>Egberg, Matthew D. ; Galanko, Joseph A. ; Kappelman, Michael D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-d5f6ca433f7c225133360aa93b720c53e7d55c948c68be7882883110812500173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>African Americans</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Colectomy - statistics & numerical data</topic><topic>Colectomy - trends</topic><topic>Colitis, Ulcerative - surgery</topic><topic>Cross-Sectional Studies</topic><topic>Epidemiology</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Guidelines</topic><topic>Hispanic Americans</topic><topic>Hospitals, High-Volume - statistics & numerical data</topic><topic>Hospitals, Low-Volume - statistics & numerical data</topic><topic>Humans</topic><topic>IBD</topic><topic>Ileus - epidemiology</topic><topic>Insurance, Health - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicaid - statistics & numerical data</topic><topic>Multivariate Analysis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Pulmonary Atelectasis - epidemiology</topic><topic>Risk Factor</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Egberg, Matthew D.</creatorcontrib><creatorcontrib>Galanko, Joseph A.</creatorcontrib><creatorcontrib>Kappelman, Michael D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Egberg, Matthew D.</au><au>Galanko, Joseph A.</au><au>Kappelman, Michael D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications</atitle><jtitle>Clinical gastroenterology and hepatology</jtitle><addtitle>Clin Gastroenterol Hepatol</addtitle><date>2019-12</date><risdate>2019</risdate><volume>17</volume><issue>13</issue><spage>2713</spage><epage>2721.e4</epage><pages>2713-2721.e4</pages><issn>1542-3565</issn><eissn>1542-7714</eissn><abstract>Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the proportion of colectomies performed at high-volume centers. We then evaluated the association between hospital colectomy volume and complications.
We performed a cross-sectional analysis of pediatric patients (age, ≤18 y) hospitalized for UC using the Kids’ Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5–0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions.
Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (<5%) are performed at high-volume centers.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30853617</pmid><doi>10.1016/j.cgh.2019.03.003</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent African Americans Child Child, Preschool Colectomy - statistics & numerical data Colectomy - trends Colitis, Ulcerative - surgery Cross-Sectional Studies Epidemiology European Continental Ancestry Group Female Guidelines Hispanic Americans Hospitals, High-Volume - statistics & numerical data Hospitals, Low-Volume - statistics & numerical data Humans IBD Ileus - epidemiology Insurance, Health - statistics & numerical data Logistic Models Male Medicaid - statistics & numerical data Multivariate Analysis Postoperative Complications - epidemiology Pulmonary Atelectasis - epidemiology Risk Factor Surgical Wound Infection - epidemiology United States - epidemiology |
| title | Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications |
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