Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-volume Hospitals Have More Complications.

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Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-volume Hospitals Have More Complications.

Clin Gastroenterol Hepatol. 2019 Mar 07;:

Authors: Egberg MD, Galanko JA, Kappelman MD

Abstract
BACKGROUND & AIMS: 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 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.
METHODS: We performed a cross-sectional analysis of pediatric patients (≤18 years) hospitalized for UC using the Kids’ Inpatient Database (KID), a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (ICD-9 or ICD-10) 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 TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
RESULTS: A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed ≥1 annual colectomy 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 to 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 non-emergent admissions.
CONCLUSION: Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (less than 5%) are performed at high-volume centers.

PMID: 30853617 [PubMed – as supplied by publisher]

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/30853617?dopt=Abstract