S. Sales1, M. Levitt3, R. Wood4, E. Borgert2, K. Simpson2, A. Simpson2, A. Simpson2 1Texas Tech University Health Sciences Center, School Of Health Professions, Lubbock, TX, USA 2Medical University Of South Carolina, Collegoeof Health Professions, Charleston, Sc, USA 3Children’s National Medical Center, Colorectal Surgery, Washington, DC, USA 4Nationwide Children’s Hospital, Center For Colorectal And Pelvic Reconstruction, Columbus, OH, USA
Introduction:
Children with congenital colorectal conditions often receive a temporary colostomy or ileostomy in the newborn period to divert stool prior to definitive surgical reconstruction, which facilitates healing in the repaired anatomy. Thereafter, the stoma is taken down with reconnection of the two ends of the bowel, a standard procedure for pediatric general surgeons. Stoma takedown surgery has been associated with a high risk of postoperative complications, including anastomotic problems and wound infections. This study seeks to determine if case volume influences the outcomes of the procedure.
Methods:
A retrospective analysis of archival billing data for pediatric stoma closure patients was conducted using the 2016 – 2017 Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project (HCUP) database. Quality outcome measures included length of stay (LOS) during the index admission and readmission to the hospital within 30 days of discharge.
Results:
339 pediatric patients from 50 hospitals in seven states underwent stoma closure surgery during the study period; 62 were Black (18.29%), 158 were White (46.61%), 119 were other (35.1%), 201 were male (59.29%), and 138 were female (40.71%). Stratified by age, 133 (39.2%) patients were infants (< 1 year), and 206 (60.8%) were non-infants (> 1 year). Comorbid conditions included renal/urologic (35), congenital defect (27), cardiovascular (25), neurologic (18), metabolic (14), respiratory (12), hematologic/malignancy/transplant (<11). 235 patients had one comorbid condition (69.32%), 64 had two conditions (18.88%), 30 had three conditions (8.85%), fewer than 11 had four conditions (<3%), and fewer than 11 had five or more conditions (< 3%).
39 patients were readmitted within 30 days (11.5%). An inverse volume-readmission relationship was identified, which was more pronounced in the infant age group. A statistically significant association was found between hospital prior-year volume and readmission (p<.037) in the infant age group (Age < 1). A similar association was found between hospital prior-year volume and LOS (p<.002) in the infant compared to the non-infant group. With each prior-year increase of 10 cases, the odds ratio of readmission decreased by 52%, and the predicted number of hospital days decreased by 25%.
Conclusion:
This study validates an inverse hospital volume-readmission association in stoma closure in infants and an inverse volume-LOS association among all pediatric patients, the most significant in the infant population. The data indicate that prior-year hospital surgical volume mediates the likelihood of readmission in complex patients, notwithstanding the complexity of the surgery. The reduced readmission rate and LOS have implications for the cost of care, patient satisfaction, and better outcomes, showing that higher-volume centers achieved better outcomes for this common pediatric surgical procedure.