title: Pediatric specialist care is associated with a lower risk of bowel resection in children with intussusception: a population-based analysis.
abstract: BACKGROUND
  Although previous studies have shown that radiologic intussusception reduction is more likely at children's hospitals, no study to date has compared outcomes among children advancing to surgical intervention. We hypothesized that rates of bowel resection would differ between hospitals with and without pediatric surgeons.
  
  
  METHODS
  We conducted a population-based retrospective cohort study using Washington State discharge records. All children younger than 18 years undergoing operative intussusception reduction between 1999 and 2009 were included (n = 327). Data were collected on demographics, disease severity, comorbidities, and concomitant gastrointestinal pathology. Multivariate logistic regression was used to estimate odds of intestinal resection during operative intussusception reduction.
  
  
  RESULTS
  Pediatric hospitals treated a smaller proportion of children older than 4 years of age (12.1% vs 44.4%), as well as a greater proportion of Medicaid patients (50.9% vs 42.6%). Patients at pediatric hospitals had a lower prevalence of underlying intestinal anomalies or identifiable mass lesions (14.3% vs 16.7%). "Severe disease" (perforation, ischemia, acidosis) was more common at pediatric hospitals (17.6% vs 9.3%). Overall, bowel resection was more commonly performed at nonpediatric hospitals (59.3% vs 33.0%). On multivariate analysis, the odds of bowel resection were significantly lower at pediatric compared with nonpediatric hospitals (odds ratio [OR] 0.20, p < 0.001), and this association was strongest in younger patients. Adjusted odds of postoperative complications were greater for bowel resection patients (OR 2.83, p < 0.001).
  
  
  CONCLUSIONS
  Bowel resection during operative intussusception reduction is more likely at hospitals without pediatric surgeons, and is associated with increased complications. Improved outcomes may be achieved by efforts aimed at standardizing care and decreasing variability in the treatment of pediatric intussusception.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA. jarodmc@u.washington.edu
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: Cabrini A
authors.initials: CA
authors.lastname: LaRiviere
authors.forename: Keith T
authors.initials: KT
authors.lastname: Oldham
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery; D006761:Hospitals / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000601:surgery*; D007443:Intussusception / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014861:Washington; D000078329:Workforce