Comparative outcome analysis of the management of pediatric intussusception with or without surgical admission.
BACKGROUND
Controversy persists about the need to admit patients after successful reduction of intussusception. Our hypothesis is that pediatric intussusception can be managed with discharge from the emergency department (ED) after reduction without increasing morbidity, yielding significant cost savings.


METHODS
A chart review over 10 years was performed at two Canadian institutions. Data abstracted included: demographics, length of stay (LOS), initial and recurrence management. Primary outcome was early recurrence and resultant management, including LOS and need for operative intervention. Costs were calculated using hospital-specific data.


RESULTS
584 patient records were assessed: 329 patients were managed with admission after reduction, 239 as outpatients. In the admission group, 28 patients had at least one recurrence (8.5%), with 8 after discharge. In the outpatient group, 21 patients had at least one recurrence (8.8%), with 19 after discharge. The difference post-discharge was significant (p=0.004). Outcomes of recurrence did not differ, with 2 patients in each group requiring operative intervention. Average LOS in the admission group was 90 h, with additional average cost of $1771 per non-operated patient.


CONCLUSIONS
Pediatric intussusception can be safely managed as an outpatient with reliable follow up. Discharge from the ED reduces hospital charges without increasing morbidity. This approach should be considered in managing patients with intussusception.
The Montreal Children's Hospital, Pediatric General and Thoracic Surgery, McGill University Health Centre.
Alana L
AL
Beres
The Montreal Children's Hospital, Pediatric General and Thoracic Surgery, McGill University Health Centre. Electronic address: robert.baird@mail.mcgill.ca.
Robert
R
Baird
The Hospital for Sick Children, Division of General and Thoracic Surgery, University of Toronto.
Eleanor
E
Fung
The Montreal Children's Hospital, Pediatric General and Thoracic Surgery, McGill University Health Centre.
Helen
H
Hsieh
The Montreal Children's Hospital, Pediatric General and Thoracic Surgery, McGill University Health Centre.
Maria
M
Abou-Khalil
The Hospital for Sick Children, Division of General and Thoracic Surgery, University of Toronto.
J
J
Ted Gerstle
D000553:Ambulatory Care / Q000191:economics*; D002170:Canada; D002675:Child, Preschool; D017046:Cost Savings; D004733:Enema; D017721:Hospital Costs; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000601:surgery / Q000628:therapy*; D007902:Length of Stay / Q000191:economics; D012008:Recurrence; D012189:Retrospective Studies
Intussusception; Outpatient; Pediatric; Recurrence; Reduction