Delayed repeat enemas are safe and cost-effective in the management of pediatric intussusception.
OBJECTIVE
The purpose of the study is to compare outcomes between delayed repeat enema (DRE) and immediate surgery (IS) in children with ileocolic intussusception who fail initial enema reduction.


METHODS
Retrospective cohort study of children <6 years-of-age from 2008 to 2012 in the Pediatric Health Information System (PHIS) database. Outcomes measured were bowel resection, length of stay (LOS), and adjusted hospital costs (AHC).


RESULTS
4980 of 6889 (72.3%) children with intussusception were discharged without operation following a single successful enema. 1407 of 1909 (73.7%) remaining patients underwent IS while 502 (26.3%) had a DRE. Bowel resection was required in 372 of 1407 (26.4%) patients in IS group compared to 59 of 502 (11.8%) in the DRE group (p<0.001). The number of patients needed to treat by DRE to prevent a bowel resection was 7. In multivariable analysis, the IS patients had a 2.5 times greater likelihood of undergoing bowel resection than the DRE patients (adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.83-3.41, p<0.001). The DRE group had a mean LOS of 3.2 days (95% CI 2.9-3.6) and mean AHC of $9205 (95% CI $7673-$10,735). The IS group had a longer LOS (4.4days, 95% CI 4.0-4.8, p≤0.001) and higher AHC ($14,422, 95% CI $12,631-$16,214, p<0.001).


CONCLUSIONS
Delayed repeat enemas for ileocolic intussusception increase the success of nonoperative reduction, decrease the rate of bowel resection and reduce mean hospital length of stay and costs.
Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: tlautz@luriechildrens.org.
Timothy B
TB
Lautz
Children's Hospital Association, Overland Park, KS, USA.
Cary W
CW
Thurm
Division of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA.
David H
DH
Rothstein
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004733:Enema / Q000009:adverse effects / Q000191:economics; D005260:Female; 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 / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D061366:Numbers Needed To Treat; D019233:Retreatment / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
Bowel resection; Intussusception; Repeat enema