title: Variation in practice patterns and resource utilization surrounding management of intussusception at freestanding Children's Hospitals.
abstract: OBJECTIVE
  To characterize variation in practice patterns and resource utilization associated with the management of intussusception at Children's Hospitals.
  
  
  METHODS
  A retrospective cohort study (1/1/09-6/30/11) of 27 Children's Hospitals participating in the Pediatric Health Information System database was performed. Hospitals were compared with regard to their rates of operative management following attempted enema reduction, prophylactic antibiotic utilization, same-day discharge for those successfully managed non-operatively, 48-h readmission rates, and case-related cost and charges.
  
  
  RESULTS
  2544 patients were identified (median: 93 cases/center) with a median age of 17 months. The rate of operation following attempted enema reduction varied significantly across hospitals (overall rate: 21.1%: range: 11%-62.8%; p<0.0001). For patients managed non-operatively, significant variability was found for prophylactic antibiotic utilization (overall rate: 23.3%; range: 1.4%-93.2%; p<0.0001), same-day discharge (overall rate: 15.2%; range: 0%-83.8%; p<0.0001), readmission rates (overall rate: 17.5%; range: 5.3%-32.1%; p<0.0001), treatment-related costs (overall median: $2490; range: $829-$5905; p<0.0001), and charges (overall median: $6350; range: $2497-$10,306; p<0.0001). Variability in costs and charges was even greater when analyzing all patients (operative and non-operative) with intussusception (overall cost median: $2865; range: $1574-$6763; p<0.0001; overall charge median: $7110; range: $3544-$22,097; p<0.0001).
  
  
  CONCLUSIONS
  Significant variation in practice patterns and resource utilization exists between Children's Hospitals in the management of intussusception. Prospective analysis of practice variation and appropriately risk-adjusted outcomes through a collaborative quality-improvement platform could accelerate the dissemination of best-practice guidelines for optimizing cost-effective care.
authors: Department of Pediatric Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. shawn.rangel@childrens.harvard.edu
authors: Samuel
authors: S
authors: Rice-Townsend
authors: Catherine
authors: C
authors: Chen
authors: Jeff N
authors: JN
authors: Barnes
authors: Shawn J
authors: SJ
authors: Rangel
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004733:Enema / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000191:economics / Q000628:therapy*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States