Postoperative complications and health care use in children undergoing surgery for ulcerative colitis

• Published in: Journal of pediatric surgery 2012-11, Vol.47 (11), p.2063-2070
• Main Authors: Kelley-Quon, Lorraine I, Tseng, Chi-Hong, Jen, Howard C, Ziring, David A, Shew, Stephen B
• Format: Article
• Language: English
• Subjects: Adolescent; California; Child; Child, Preschool; Cohort Studies; Colectomy; Colitis, Ulcerative - surgery; Female; Health care use; Hospitalization - statistics & numerical data; Hospitals, Pediatric - statistics & numerical data; Humans; Inflammatory bowel disease; Length of Stay - statistics & numerical data; Linear Models; Logistic Models; Male; Multivariate Analysis; Patient Readmission - statistics & numerical data; Pediatrics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctocolectomy; Proctocolectomy, Restorative - methods; Retrospective Studies; Surgery; Treatment Outcome; Ulcerative colitis
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2012.07.001

Abstract Objectives Medical and surgical approaches toward children with ulcerative colitis (UC) vary and have differing implications for health care use. The goal of this study was to define hospital use and complications for children with UC before and after staged restorative proctocolectomy. Patients and Methods A retrospective study of the California Patient Discharge Dataset from 1999 to 2007 of children aged 2 to 18 years with UC who underwent colectomy was performed (N = 218). Surgical staging was determined alongside hospital type (children's vs non-children's) and surgical case volume. Postoperative complications and hospital length of stay were analyzed using multivariate regression. Results The cohort was mostly male (56%) and white (80%), had private insurance (78%), and underwent colectomy at a children's hospital (62%). Overall, 65% required a separate hospital admission before admission for colectomy. Single-, 2-, and 3-stage procedures were performed in 19 (9%), 144 (66%), and 38 (17%) children. The mean admissions per patient were 1.8 ± 2.4 before colectomy and 0.7 ± 1.6 after surgical completion. Surgical complications occurred in 100 (49%) children, with 39% being attributed to postoperative infection. Children with public insurance (odds ratio, 2.18; 95% confidence interval, 1.0-4.85) and those who underwent colectomy at a non–children's hospital (odds ratio, 2.53; 95% confidence interval, 1.0-6.37) had increased likelihood of surgical complications. Finally, nonwhite race, surgical staging, and undergoing colectomy at a low- or medium-volume hospital resulted in prolonged hospitalization ( P < .05). Conclusions Children with UC who undergo colectomy use a large number of hospital resources before surgery and exhibit decreased hospital use after surgical completion. Children undergoing colectomy at children's and high-volume hospitals experience fewer surgical complications and shorter hospitalization.