title: Outcomes and costs of surgical treatments of necrotizing enterocolitis.
abstract: OBJECTIVE
  Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score-matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC.
  
  
  METHODS
  Utilizing the California OSHPD Linked Birth File Dataset, 1375 infants with surgical NEC between 1999 and 2007 were retrospectively propensity score matched according to intervention type. Total in-hospital costs were converted from longitudinal patient charges. A multivariate mixed effects model compared adjusted costs and mortality between groups.
  
  
  RESULTS
  Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was $398,173 (95% confidence interval [CI]: 287,784-550,907), which was more than for peritoneal drainage ($276,076 [95% CI: 196,238-388,394]; P = .004) and similar to laparotomy ($341,911 [95% CI: 251,304-465,186]; P = .08). Adjusted mortality was highest after peritoneal drainage (56% [95% CI: 34-75]) versus peritoneal drainage followed by laparotomy (35% [95% CI: 19-56]; P = .01) and laparotomy (29% [95% CI: 19-56]; P < .001). Mortality for peritoneal drainage was similar to laparotomy.
  
  
  CONCLUSIONS
  Propensity score-matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs.
authors: Department of Surgery, Mount Sinai Medical Center, New York, New York; Division of Pediatric Surgery, Department of Surgery.
authors: Anne
authors: A
authors: Stey
authors: Department of Pediatrics, and.
authors: Elizabeth S
authors: ES
authors: Barnert
authors: Division of Health Services Research, Department of Internal Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California;
authors: Chi-Hong
authors: CH
authors: Tseng
authors: RAND Corporation, Santa Monica, California; and.
authors: Emmett
authors: E
authors: Keeler
authors: Department of Health Policy and Management, Fielding School of Public Health at the University California, Los Angeles, Los Angeles, California.
authors: Jack
authors: J
authors: Needleman
authors: Division of Health Services Research, Department of Internal Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California;
authors: Mei
authors: M
authors: Leng
authors: Division of Pediatric Surgery, Department of Surgery.
authors: Lorraine I
authors: LI
authors: Kelley-Quon
authors: Division of Pediatric Surgery, Department of Surgery, sshew@mednet.ucla.edu.
authors: Stephen B
authors: SB
authors: Shew
mesh_terms: D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000379:methods; D004322:Drainage; D020345:Enterocolitis, Necrotizing / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cost analysis; mortality; necrotizing enterocolitis; prematurity; surgery