Outcomes of diverting jejunostomy for severe necrotizing enterocolitis

Thyoka, Mandela; Eaton, Simon; Kiely, Edward M.; Curry, Joe; Drake, D. P.; Cross, Kate; Hall, Nigel; Khoo, Andrew; Coppi, Paolo De; Pierro, Agostino

doi:10.1016/j.jpedsurg.2011.03.024

Cited by 23 publications

(17 citation statements)

References 17 publications

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“…[2][3][4][5][6][7][8] Some retrospective studies have similarly demonstrated that infants undergoing peritoneal drainage alone may have higher morbidity and mortality. 1,19,[25][26][27] Prospective trials have not shown a difference, perhaps as a result of an intention-to-treat analysis with high rates of crossover (35%-74%) in which the peritoneal drainage group included infants who underwent peritoneal drainage followed by laparotomy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Despite modern advances in neonatal care, mortality remains frequent, with rates reported between 18% and 63%. [2][3][4][5][6][7][8] Clinical management of critically ill neonates, 9 and with NEC in particular, carries considerable financial costs. 10,11 If medical management fails, operative management is pursued, including either laparotomy or placement of a percutaneous peritoneal drain.…”

Section: What This Study Addsmentioning

confidence: 99%

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Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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BACKGROUND AND OBJECTIVES: 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. 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 $ 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. WHAT'S KNOWN ON THIS SUBJECT:Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated. WHAT THIS STUDY ADDS:After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a costbenefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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“…The aim of this technique was to reduce the extent of resection, based on the principle that it is difficult to predict the recovery potential of lesions observed in the acute phase. This technique is thought to increase the final length of the digestive tract conserved [36]. According to Luzzatto, among 23 cases of severe NEC requiring laparotomy with proximal diversion without resection, 21% of infants in the acute phase showed pan-intestinal damage while 36% showed pan-colitic damage.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Enterocolitis (NEC) and the Risk of Intestinal Stricture: The Value of C-Reactive Protein

et al. 2013

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Necrotizing enterocolitis (NEC) is a severe complication frequently seen during the neonatal period associated with high mortality rate and severe and prolonged morbidity including Post-NEC intestinal stricture. The aim of this study is to define the incidence and risk factors of these post-NEC strictures, in order to better orient their medicosurgical care. Sixty cases of NEC were retrospectively reviewed from a single tertiary center with identical treatment protocols throughout the period under study, including systematic X-ray contrast study. This study reports a high rate of post-NEC intestinal stricture (n = 27/48; 57% of survivors), either in cases treated surgically (91%) and after the medical treatment of NEC (47%). A colonic localization of the strictures was more frequent in medically-treated patients than in those with NEC treated surgically (87% vs. 50%). The length of the strictures was significantly shorter in case of NEC treated medically. No deaths were attributable to the presence of post-NEC stricture. The mean hospitalization time in NICU and the median age at discontinuation of parenteral nutrition were longer in the group with stricture, but this difference was not significant. The median age at discharge was significantly higher in the group with stricture (p = 0.02). The occurrence of post-NEC stricture was significantly associated with the presence of parietal signs of inflammation and thrombopenia (<100 000 platelets/mm3). The mean maximum CRP concentration during acute phase was significantly higher in infants who developed stricture (p<0.001), as was the mean duration of the elevation of CRP levels (p<0.001). The negative predictive value of CRP levels continually <10 mg/dL for the appearance of stricture was 100% in our study. In conclusion, this retrospective and monocentric study demonstrates the correlation between the intensity of the inflammatory syndrome and the risk of secondary intestinal stricture, when systematic contrast study is performed following NEC.

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“…The mortality rates in the present study were within the published ranges of 18% to 63%. [2][3][4][5][6][7][8] Some retrospective studies have similarly demonstrated that infants undergoing peritoneal drainage alone may have higher morbidity and mortality. 1,19,[25][26][27] Prospective trials have not shown a difference, perhaps as a result of an intention-to-treat analysis with high rates of crossover (35%-74%) in which the peritoneal drainage group included infants who underwent peritoneal drainage followed by laparotomy.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

2015

PEDIATRICS

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BACKGROUND AND OBJECTIVES: 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 ; 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.

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Outcomes of diverting jejunostomy for severe necrotizing enterocolitis

Cited by 23 publications

References 17 publications

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Necrotizing Enterocolitis (NEC) and the Risk of Intestinal Stricture: The Value of C-Reactive Protein

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

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