title: Magnitude of surgical burden associated with pediatric intestinal failure: a multicenter cohort analysis.
abstract: BACKGROUND
  Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown.
  
  
  METHODS
  Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for >60days.
  
  
  RESULTS
  A total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (P<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3 (1, 6) versus 1 (0, 3), respectively, P<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing >2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment.
  
  
  CONCLUSIONS
  Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Clinical Research Center, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mitchell
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Department of Surgery, CS Mott Children's Hospital, Ann Arbor, MI, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA. Electronic address: biren.modi@childrens.harvard.edu.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
keywords: Pediatric intestinal failure; Sepsis; Short bowel syndrome; Surgical burden