W. S. Do1, C. W. Marenco1, J. D. Horton1, M. A. Escobar1 1Mary Bridge Children’s Health Center,Pediatric Surgery,Tacoma, WA, USA
Introduction:
Historically, small cohort studies have shown a bowel resection rate of 22% at the time of Ladd procedure for malrotation. Patients who undergo bowel resection at the time of Ladd procedure present with more advanced disease. The objective of this study was to identify risk factors for bowel resection (a surrogate marker for disease severity) in a larger, modern cohort of patients undergoing non-elective Ladd procedures.
Methods:
This was a retrospective descriptive analysis of patients who had a Ladd procedure (CPT 44055) in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012-2015. Exclusion criteria were: elective case, atresias or other known congenital anomaly (except cardiac, structural CNS, or airway anomaly), and open wounds from prior procedures. Descriptive statistics were performed on all pre-operative variables collected by NSQIP-P (listed in results). The primary outcome variable was bowel resection as a concurrent procedure. Univariate analysis was performed using Pearson Chi-square or ANOVA for categorical variables and t-testing for continuous variables. Multivariate analysis was performed by incorporating all variables into a stepwise forward logistic regression model to identify independent risk factors for bowel resection.
Results:
Of the 267,289 patients captured in NSQIP-P, a total of 1284 had a Ladd procedure. Of these, 292 were performed urgently/emergently in children with no known atresias, aforementioned congenital anomalies, or open wounds from prior procedures. Descriptive statistics in this cohort were: 46% age 0-30 days, 33% age >1 year, 68% weight ≤10 kg, 68% male, 21% history of prematurity, 8% ventilator dependence, 2% asthma, 2% chronic lung disease, 8% oxygen support, 1% tracheostomy, 2% structural airway abnormality, 73% esophageal/gastric/intestinal disease, 1% biliary/liver/pancreatic disease, 11% cardiac risk factors, 9% developmental delay, 3% cerebral palsy, 3% structural CNS abnormality, 2% neuromuscular disorder, 1% intraventricular hemorrhage, 1% steroid use, 14% nutritional support, 2% hematologic disorder, 0.3% malignancy, 8% SIRS, 1% septic shock, 3% inotropic support, 1% CPR, and 18% WBC >15k. Overall bowel resection rate was 10%. Higher rates of bowel resection were observed in patients with cardiac risk factors, WBC >15k, oxygen support, and developmental delay (Table 1, left; all other variables were not significant on univariate analysis). Of these, only cardiac risk factors and WBC >15k were significant on multivariate analysis (Table 1, right).
Conclusion:
Bowel resections (performed in 10% of this cohort of non-elective Ladd procedures) were independently associated with cardiac risk factors and WBC >15k.
