The impact of children's hospital designation on outcomes in children with malrotation.
BACKGROUND
The benefit of Ladd's procedure for malrotation at a Children's Hospital (CH) has not previously been established. Our aim was to characterize the potential variations in management and outcomes between CH and Non-Children's Hospitals (NCH) in the treatment of malrotation with Ladd's procedure.


METHODS
There were 2827 children identified with malrotation and complete information from the Kids' Inpatient Database (2003, 2006, 2009). Outcomes were compared between CH and NCH and evaluated with logistic and linear regressions. Additional propensity score matching was used to balance covariates between CH and NCH.


RESULTS
There were 2261 (80.0%) children with malrotation undergoing Ladd's procedures treated at CH; 566 (20.0%) were treated at NCH. In multivariate analysis, CH was associated with a 39% lower odds of resection (p=0.004), with no differences observed for mortality, morbidity and LOS. Comparison of a propensity score matched cohort confirmed these findings, as well as demonstrated no significant differences in associated costs.


CONCLUSIONS
The majority of pediatric intestinal malrotation is managed at CH. While measured outcomes of mortality, morbidity, LOS, and costs were not different at NCH, CH was less likely to perform intestinal resection during Ladd's procedure.
Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States; Division of Outcomes, Research and Quality, Department of Surgery and Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Afif N
AN
Kulaylat
Division of Outcomes, Research and Quality, Department of Surgery and Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States. Electronic address: chollenbeak@hmc.psu.edu.
Christopher S
CS
Hollenbeak
Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Brett W
BW
Engbrecht
Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Peter W
PW
Dillon
Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
Shawn D
SD
Safford
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D004065:Digestive System Abnormalities / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D045822:Intestinal Volvulus / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D057216:Propensity Score; D016896:Treatment Outcome
Children's Hospital; Hospital designation; Intestinal malrotation; Kids' Inpatient Database; Ladd's procedure; Volvulus