Timing of enterostomy closure for neonatal isolated intestinal perforation
No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost. Using 2012 to 20...
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| Veröffentlicht in: | Journal of pediatric surgery 2020-08, Vol.55 (8), p.1535-1541 |
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| creator | Bonasso, Patrick C Dassinger, M. Sidney Mehl, Steven C. Gokun, Yevgeniya Gowen, Marie S. Burford, Jeffrey M. Smith, Samuel D. |
| description | No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost.
Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons.
Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44–2.53; p |
| doi_str_mv | 10.1016/j.jpedsurg.2019.12.001 |
| format | Article |
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Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons.
Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44–2.53; p < .0001). The median length of stay for A1 was 95 days (95% CI: 78–102 days) versus A2 length of stay of 67 days (95% CI: 56–76 days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR: 0.78; 95% CI for RR: 0.64–0.95; p-value = 0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (p < 0.001).
Neonates with IIP have a 28 day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22 day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions.
Prognosis Study.
Level II.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2019.12.001</identifier><identifier>PMID: 31954555</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Enterostomy - methods ; Enterostomy - statistics & numerical data ; Gestational Age ; Humans ; Infant, Newborn ; Intestinal Perforation - epidemiology ; Intestinal Perforation - surgery ; Isolated intestinal perforation ; Length of Stay - statistics & numerical data ; Time Factors</subject><ispartof>Journal of pediatric surgery, 2020-08, Vol.55 (8), p.1535-1541</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-4cf0d392a90a381c3bfed460b9b67a0991630450bf3f9c32f3b19d47bd6757fc3</citedby><cites>FETCH-LOGICAL-c368t-4cf0d392a90a381c3bfed460b9b67a0991630450bf3f9c32f3b19d47bd6757fc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpedsurg.2019.12.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31954555$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bonasso, Patrick C</creatorcontrib><creatorcontrib>Dassinger, M. Sidney</creatorcontrib><creatorcontrib>Mehl, Steven C.</creatorcontrib><creatorcontrib>Gokun, Yevgeniya</creatorcontrib><creatorcontrib>Gowen, Marie S.</creatorcontrib><creatorcontrib>Burford, Jeffrey M.</creatorcontrib><creatorcontrib>Smith, Samuel D.</creatorcontrib><title>Timing of enterostomy closure for neonatal isolated intestinal perforation</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost.
Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons.
Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44–2.53; p < .0001). The median length of stay for A1 was 95 days (95% CI: 78–102 days) versus A2 length of stay of 67 days (95% CI: 56–76 days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR: 0.78; 95% CI for RR: 0.64–0.95; p-value = 0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (p < 0.001).
Neonates with IIP have a 28 day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22 day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions.
Prognosis Study.
Level II.</description><subject>Enterostomy - methods</subject><subject>Enterostomy - statistics & numerical data</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Intestinal Perforation - epidemiology</subject><subject>Intestinal Perforation - surgery</subject><subject>Isolated intestinal perforation</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Time Factors</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMtKxDAUhoMoOl5eQbp003qSNOlkp4hXBDe6DmlyIhnaZkw6gm9vZEa3rg4cvv9cPkLOKTQUqLxcNas1urxJ7w0DqhrKGgC6RxZUcFoL4N0-WQAwVvNWLo_Icc4rgNIGekiOOFWiFUIsyNNrGMP0XkVf4TRjinmO41dlh1hmY-VjqiaMk5nNUIUcBzOjq0Ih8xym0ltjKoyZQ5xOyYE3Q8azXT0hb3e3rzcP9fPL_ePN9XNtuVzOdWs9OK6YUWD4klree3SthF71sjOgFJUcWgG9515ZzjzvqXJt1zvZic5bfkIutnPXKX5syiF6DNniMJhy6SZrxlvGheSKFlRuUVseywm9XqcwmvSlKegfj3qlfz3qH4-aMl08luD5bsemH9H9xX7FFeBqC2D59DNg0tkGnCy6kNDO2sXw345vpeeIpA</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Bonasso, Patrick C</creator><creator>Dassinger, M. Sidney</creator><creator>Mehl, Steven C.</creator><creator>Gokun, Yevgeniya</creator><creator>Gowen, Marie S.</creator><creator>Burford, Jeffrey M.</creator><creator>Smith, Samuel 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>202008</creationdate><title>Timing of enterostomy closure for neonatal isolated intestinal perforation</title><author>Bonasso, Patrick C ; Dassinger, M. Sidney ; Mehl, Steven C. ; Gokun, Yevgeniya ; Gowen, Marie S. ; Burford, Jeffrey M. ; Smith, Samuel D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-4cf0d392a90a381c3bfed460b9b67a0991630450bf3f9c32f3b19d47bd6757fc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Enterostomy - methods</topic><topic>Enterostomy - statistics & numerical data</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Intestinal Perforation - epidemiology</topic><topic>Intestinal Perforation - surgery</topic><topic>Isolated intestinal perforation</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bonasso, Patrick C</creatorcontrib><creatorcontrib>Dassinger, M. Sidney</creatorcontrib><creatorcontrib>Mehl, Steven C.</creatorcontrib><creatorcontrib>Gokun, Yevgeniya</creatorcontrib><creatorcontrib>Gowen, Marie S.</creatorcontrib><creatorcontrib>Burford, Jeffrey M.</creatorcontrib><creatorcontrib>Smith, Samuel 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>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bonasso, Patrick C</au><au>Dassinger, M. Sidney</au><au>Mehl, Steven C.</au><au>Gokun, Yevgeniya</au><au>Gowen, Marie S.</au><au>Burford, Jeffrey M.</au><au>Smith, Samuel D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Timing of enterostomy closure for neonatal isolated intestinal perforation</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2020-08</date><risdate>2020</risdate><volume>55</volume><issue>8</issue><spage>1535</spage><epage>1541</epage><pages>1535-1541</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost.
Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons.
Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44–2.53; p < .0001). The median length of stay for A1 was 95 days (95% CI: 78–102 days) versus A2 length of stay of 67 days (95% CI: 56–76 days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR: 0.78; 95% CI for RR: 0.64–0.95; p-value = 0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (p < 0.001).
Neonates with IIP have a 28 day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22 day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions.
Prognosis Study.
Level II.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31954555</pmid><doi>10.1016/j.jpedsurg.2019.12.001</doi><tpages>7</tpages></addata></record> |
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| subjects | Enterostomy - methods Enterostomy - statistics & numerical data Gestational Age Humans Infant, Newborn Intestinal Perforation - epidemiology Intestinal Perforation - surgery Isolated intestinal perforation Length of Stay - statistics & numerical data Time Factors |
| title | Timing of enterostomy closure for neonatal isolated intestinal perforation |
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