Variation in Surgical Outcomes for Adolescents and Young Adults With Inflammatory Bowel Disease

Jan, Sophie; Slap, Gail B.; Dai, Dingwei; Rubin, David M.

doi:10.1542/peds.2012-1427j

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…It is worth mentioning that hospital experience in IBD-related surgery was not related to the rate of ePOCs, except for anastomotic leak, which was more common in hospitals with <30 surgeries performed between 2007 and 2010 than in hospitals with >60 surgeries performed during the same time period ( P = 0.001). This finding is similar to that of previous studies, where surgeon experience was associated with better outcomes [22, 23]. In our study, most of the surgeries were performed by specialized colorectal surgeons, thus explaining the low rate of differences found.…”

Section: Discussionsupporting

confidence: 92%

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Gutiérrez

Rivero

Martín-Arranz³

et al. 2019

Gastroenterology Report

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Background This study is aimed at describing the prevalence of and risk factors associated with early post-operative complications after Crohn’s disease-related intestinal resection. Methods This was a retrospective analysis of data from the PRACTICROHN cohort. Adult Crohn’s disease patients who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010 were included. The complications evaluated included death, ileus, anastomotic leak, abscess, wound infection, catheter-related infection, digestive bleeding and other extra-abdominal infections that occurred in the 30 days after surgery. Results A total of 364 patients (median age at surgery 38 years and 50% men) were included. Indication for surgery was: stricturing disease (46.4%), penetrating disease (31.3%), penetrating and stricturing disease (14.0%) or resistance to medical treatment (5.8%). Early complications were recorded in 100 (27.5%) patients, with wound infection, intra-abdominal abscess and anastomotic leakage being the most frequent complications. Median hospitalization duration was 16 days for patients with complications vs. 9 days without complications ( P < 0.001). Complications were more common among patients with penetrating disease (36/114, 31.6%) and those refractory to treatment (9/21, 42.9%) compared with stricturing disease (45/169, 26.6%) or stricturing + penetrating disease (6/51, 11.8%) ( P = 0.040). The rate of complications was higher among patients with diagnosis made at the time of surgery (15/31, 48.4%) compared with the rest (85/331, 25.7%) ( P = 0.013). Medication received at the time of surgery did not affect the rate of complications. Conclusions Almost a quarter of patients developed early complications after intestinal resection. Penetrating disease and urgent surgery were associated with an increased risk of complications.

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Section: Discussionsupporting

confidence: 92%

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Gutiérrez

Rivero

Martín-Arranz³

et al. 2019

Gastroenterology Report

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“…The highly varied opioid exposure proportion across hospitals after accounting for patient demographic and clinical differences suggests, however, that patients with similar conditions may get different pain management if they go to different hospitals. Hospital-level variations have been reported for many aspects of clinical care and outcomes, such as cesarean delivery proportion, 21 surgical outcomes, 22 and readmission proportion, 23 but few studies reported the hospital-level variations on opioid use patterns among pediatric inpatients. A previous study by members of our research team reported that among 1466 pediatric patients dying from cancer, opioid prescription varied substantially across children's hospitals.…”

Section: Discussionmentioning

confidence: 99%

Variation of Opioid Use in Pediatric Inpatients Across Hospitals in the U.S.

Womer

Zhong

Kraemer

et al. 2014

Journal of Pain and Symptom Management

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“…Similar to previous research, children's hospitals were defined according to (i) American Hospital Association (AHA) children's hospital designation; or (ii) institutions that had 10 or more pediatric subspecialties recorded in the database. 19 Hospitals that did not meet this criterion were categorized as general community hospitals.…”

Section: Methodsmentioning

confidence: 99%

Variation in Resource Utilization for the Management of Uncomplicated Community-Acquired Pneumonia across Community and Children's Hospitals

Leyenaar

Lagu

Shieh

et al. 2014

The Journal of Pediatrics

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Objective To describe patterns of diagnostic testing and antibiotic management of uncomplicated pneumonia in general community hospitals and children's hospitals within hospitals, and to determine the association between diagnostic testing and length of hospital stay. Study design We conducted a retrospective cohort study of children 1-17 years of age hospitalized with the diagnosis of pneumonia from 2007-2010 to hospitals contributing data to Perspective Database Warehouse, assessing patterns of diagnostic testing and antibiotic management. We constructed logistic regression models of log-transformed length of stay and grouped treatment models to ascertain whether performance of blood cultures and viral respiratory testing were associated with length of stay. Results 17299 pneumonia cases occurred at 125 hospitals, with considerable variability in pneumonia management. Only 40 (0.2%) received ampicillin/penicillin G alone or in combination with other antibiotics, and 1318 (7.4%) received macrolide monotherapy as initial antibiotic management. Performance of blood culture and testing for respiratory viruses was associated with a statistically significant longer length of stay, but these differences did not persist in grouped treatment models. Conclusions We observed higher rates of diagnostic testing in this cohort of structurally diverse hospitals than previously reported at freestanding children's hospitals, with extremely low rates of narrow-spectrum antibiotic use. Tailored antibiotic stewardship initiatives at these hospitals are needed to achieve adherence to national guideline recommendations.

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Variation in Surgical Outcomes for Adolescents and Young Adults With Inflammatory Bowel Disease

Cited by 15 publications

References 26 publications

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Variation of Opioid Use in Pediatric Inpatients Across Hospitals in the U.S.

Variation in Resource Utilization for the Management of Uncomplicated Community-Acquired Pneumonia across Community and Children's Hospitals

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