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Effect of Healthcare Utilization Prior to Presentation on Perforated Pediatric Appendicitis Rates
e140
Scientific Poster Presentations: 2017 Clinical Congress
between preoperative patient characteristics and complications were assessed. RESULTS: A total of 260 patients were included, of which 177 (68.1%) were 13-18 years old. Most RP-IPAA were performed for UC (56.2%) and most cases were performed laparoscopically (58.1%). There were high rates of reoperation (12.7%) and readmission (21.5%). On bivariate analysis, obesity and preoperative steroid use were associated with complications. Multivariable regression analysis showed that obesity was independently associated with reoperation (3.7 [1.1-12.6], p¼0.039). There were no significant differences in reoperation or other morbidity for IBD vs FAP, or for laparoscopic vs open surgery. CONCLUSIONS: Children undergoing a RP-IPAA are at a high risk for reoperation and readmission. We found that preoperative obesity is independently associated with reoperation. This information can be used to counsel patients and their families in order to set realistic expectations, and in some cases, to optimize outcomes when there are modifiable risk factors. Breaking Point: Rib Fracture Risk Stratification in Pediatric Patients Tianyi Swartz, Arpana Jain, MD, Muhammad Khan, MD, Fahad S Ahmed, MD, Terence O’ Keeffe, MB ChB, FACS, Gary Vercryusee, MD, Andrew L Tang, MD, FACS, Bellal Joseph, MD, FACS University of Arizona, Tuscon, AZ INTRODUCTION: Chest trauma is commonly encountered in the pediatric population and has a high morbidity and mortality; however, the association of number of rib fractures with worse outcomes remains unclear in the pediatric population. The aim of our study is to investigate the relationship between rib fractures and outcomes in pediatric trauma patients. METHODS: A 2-year (2011 to 2012) review of all patients’ age<18 with rib fractures in the NTDB. Data were collected for demographics, injury parameters, and number of rib fractures. Outcome measures were pulmonary complications (respiratory distress syndrome [ARDS] and pneumonia), hospital and ICU, length-of-stay (LOS), ventilator days, and hospital mortality. Multiple logistic and linear regression analyses were performed. RESULTS: A total of 7,922 patients were included. Mean age was 144 years with ISS 17[9-25]. Mortality rate was 3.9%. On regression, sustaining 5 rib fractures was associated with increased ICU admission (odds ratio [OR]:1.5, p<0.01) and need for mechanical ventilation (OR:1.4, p< 0.01). Sustaining 6 rib fractures was associated with increased risk of pneumonia (OR: 2.4, p<0.01) while sustaining 8 rib fractures was independently associated with increased odds of developing ARDS (OR: 2.25, p¼0.002). In addition, increasing number of rib fractures was independently associated with higher ventilator days (p¼0.004), ICU LOS (p<0.01) and hospital-LOS (p<0.01) in a dose-dependent fashion. However, increasing number of rib fractures was not independently associated with mortality (p¼0.34) when adjusted for confounders.
J Am Coll Surg
CONCLUSIONS: Sustaining 5 or more rib fractures is independently associated with worse outcomes in pediatric trauma patients. This should help in the timely resource allocation and decision of admission to ICU and mechanical ventilation. Effect of Healthcare Utilization Prior to Presentation on Perforated Pediatric Appendicitis Rates Katherine J Baxter, MD, Hannah TMH Nguyen, Mark L Wulkan, MD, Mehul V Raval, MD Children’s Healthcare of Atlanta, Emory University, Atlanta, GA INTRODUCTION: The purpose of this study is to determine whether utilization of healthcare (ie primary care visits) in the year prior to presentation is associated with lower complicated appendicitis rates in children. METHODS: A retrospective cohort study was performed using Truven MarketScan national insurance claims database. We identified cases of appendicitis in children (1-18 years) from 2010 to 2013. Utilization of healthcare was defined as 1 outpatient encounter in the year preceding presentation with appendicitis. Logistic regression was performed to predict presentation with complicated appendicitis, using healthcare utilization as the key independent variable and adjusting for age, sex, geographical region, and insurance type. RESULTS: Of 39,740 children identified with appendicitis, 30,940 (77.9%) had an outpatient visit prior to presentation. Of the 12,159 (30.6%) classified as complicated appendicitis, 9060 (74.5%) had an outpatient visit prior to presentation. In the adjusted model, older patients were less likely to present with complicated appendicitis (odds ratio [OR] 0.91 per year, 95% CI 0.91-0.92). Patients in the Midwest (OR 1.45, 95% CI 1.351.56) and Southern regions (OR 1.30, 95% CI 1.21-1.39) had higher odds of presentation with complicated appendicitis. Children with one or more outpatient visits in the year prior to presentation had lower odds of complicated appendicitis compared to children with no visits, OR 0.76, 95% CI 0.72-0.81. CONCLUSIONS: Among insured children, increased healthcare utilization was associated with lower rates of complicated appendicitis. This finding highlights the role of utilization of primary care as a metric for quality improvement that is relevant to surgical outcomes. Thoracoscopic Approach Provides a Safe Alternative to Open Surgery in Elective Cases for Newborns Harold J Leraas, Jina Kim, MD, Uttara Nag, MD, Brian Ezekian, MD, Brian C Gulack, MD, Christopher R Reed, MD, Henry E Rice, MD, Elisabeth T Tracy, MD Duke University Medical Center, Durham, NC INTRODUCTION: As experience with minimally invasive surgery has grown over recent decades, surgeons have extended these
Scientific Poster Presentations: 2017 Clinical Congress
between preoperative patient characteristics and complications were assessed. RESULTS: A total of 260 patients were included, of which 177 (68.1%) were 13-18 years old. Most RP-IPAA were performed for UC (56.2%) and most cases were performed laparoscopically (58.1%). There were high rates of reoperation (12.7%) and readmission (21.5%). On bivariate analysis, obesity and preoperative steroid use were associated with complications. Multivariable regression analysis showed that obesity was independently associated with reoperation (3.7 [1.1-12.6], p¼0.039). There were no significant differences in reoperation or other morbidity for IBD vs FAP, or for laparoscopic vs open surgery. CONCLUSIONS: Children undergoing a RP-IPAA are at a high risk for reoperation and readmission. We found that preoperative obesity is independently associated with reoperation. This information can be used to counsel patients and their families in order to set realistic expectations, and in some cases, to optimize outcomes when there are modifiable risk factors. Breaking Point: Rib Fracture Risk Stratification in Pediatric Patients Tianyi Swartz, Arpana Jain, MD, Muhammad Khan, MD, Fahad S Ahmed, MD, Terence O’ Keeffe, MB ChB, FACS, Gary Vercryusee, MD, Andrew L Tang, MD, FACS, Bellal Joseph, MD, FACS University of Arizona, Tuscon, AZ INTRODUCTION: Chest trauma is commonly encountered in the pediatric population and has a high morbidity and mortality; however, the association of number of rib fractures with worse outcomes remains unclear in the pediatric population. The aim of our study is to investigate the relationship between rib fractures and outcomes in pediatric trauma patients. METHODS: A 2-year (2011 to 2012) review of all patients’ age<18 with rib fractures in the NTDB. Data were collected for demographics, injury parameters, and number of rib fractures. Outcome measures were pulmonary complications (respiratory distress syndrome [ARDS] and pneumonia), hospital and ICU, length-of-stay (LOS), ventilator days, and hospital mortality. Multiple logistic and linear regression analyses were performed. RESULTS: A total of 7,922 patients were included. Mean age was 144 years with ISS 17[9-25]. Mortality rate was 3.9%. On regression, sustaining 5 rib fractures was associated with increased ICU admission (odds ratio [OR]:1.5, p<0.01) and need for mechanical ventilation (OR:1.4, p< 0.01). Sustaining 6 rib fractures was associated with increased risk of pneumonia (OR: 2.4, p<0.01) while sustaining 8 rib fractures was independently associated with increased odds of developing ARDS (OR: 2.25, p¼0.002). In addition, increasing number of rib fractures was independently associated with higher ventilator days (p¼0.004), ICU LOS (p<0.01) and hospital-LOS (p<0.01) in a dose-dependent fashion. However, increasing number of rib fractures was not independently associated with mortality (p¼0.34) when adjusted for confounders.
J Am Coll Surg
CONCLUSIONS: Sustaining 5 or more rib fractures is independently associated with worse outcomes in pediatric trauma patients. This should help in the timely resource allocation and decision of admission to ICU and mechanical ventilation. Effect of Healthcare Utilization Prior to Presentation on Perforated Pediatric Appendicitis Rates Katherine J Baxter, MD, Hannah TMH Nguyen, Mark L Wulkan, MD, Mehul V Raval, MD Children’s Healthcare of Atlanta, Emory University, Atlanta, GA INTRODUCTION: The purpose of this study is to determine whether utilization of healthcare (ie primary care visits) in the year prior to presentation is associated with lower complicated appendicitis rates in children. METHODS: A retrospective cohort study was performed using Truven MarketScan national insurance claims database. We identified cases of appendicitis in children (1-18 years) from 2010 to 2013. Utilization of healthcare was defined as 1 outpatient encounter in the year preceding presentation with appendicitis. Logistic regression was performed to predict presentation with complicated appendicitis, using healthcare utilization as the key independent variable and adjusting for age, sex, geographical region, and insurance type. RESULTS: Of 39,740 children identified with appendicitis, 30,940 (77.9%) had an outpatient visit prior to presentation. Of the 12,159 (30.6%) classified as complicated appendicitis, 9060 (74.5%) had an outpatient visit prior to presentation. In the adjusted model, older patients were less likely to present with complicated appendicitis (odds ratio [OR] 0.91 per year, 95% CI 0.91-0.92). Patients in the Midwest (OR 1.45, 95% CI 1.351.56) and Southern regions (OR 1.30, 95% CI 1.21-1.39) had higher odds of presentation with complicated appendicitis. Children with one or more outpatient visits in the year prior to presentation had lower odds of complicated appendicitis compared to children with no visits, OR 0.76, 95% CI 0.72-0.81. CONCLUSIONS: Among insured children, increased healthcare utilization was associated with lower rates of complicated appendicitis. This finding highlights the role of utilization of primary care as a metric for quality improvement that is relevant to surgical outcomes. Thoracoscopic Approach Provides a Safe Alternative to Open Surgery in Elective Cases for Newborns Harold J Leraas, Jina Kim, MD, Uttara Nag, MD, Brian Ezekian, MD, Brian C Gulack, MD, Christopher R Reed, MD, Henry E Rice, MD, Elisabeth T Tracy, MD Duke University Medical Center, Durham, NC INTRODUCTION: As experience with minimally invasive surgery has grown over recent decades, surgeons have extended these