Faraz A Khan1, Paul D Mitchell2, Jeremy G Fisher1, Eric A Sparks1, Tom Jaksic1, Christopher Duggan3, Daniel H Teitelbaum4, Biren P Modi5. 1. Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA. 2. Clinical Research Center, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA. 3. Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA. 4. Department of Surgery, CS Mott Children's Hospital, Ann Arbor, MI, USA. 5. Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA. Electronic address: biren.modi@childrens.harvard.edu.
Abstract
BACKGROUND: Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown. METHODS: Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for >60days. RESULTS: A total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (P<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3 (1, 6) versus 1 (0, 3), respectively, P<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing >2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment. CONCLUSIONS: Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
BACKGROUND:Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown. METHODS: Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for >60days. RESULTS: A total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitispatients versus 138/175 (80%) in non-NEC patients (P<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3 (1, 6) versus 1 (0, 3), respectively, P<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing >2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment. CONCLUSIONS: Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
Authors: Patrick J Javid; Frances R Malone; Rachel Bittner; Patrick J Healey; Simon P Horslen Journal: J Pediatr Surg Date: 2011-06 Impact factor: 2.545
Authors: Biren P Modi; Patrick J Javid; Tom Jaksic; Hannah Piper; Monica Langer; Christopher Duggan; Daniel Kamin; Heung Bae Kim Journal: J Am Coll Surg Date: 2007-03 Impact factor: 6.113
Authors: Robert H Squires; Christopher Duggan; Daniel H Teitelbaum; Paul W Wales; Jane Balint; Robert Venick; Susan Rhee; Debra Sudan; David Mercer; J Andres Martinez; Beth A Carter; Jason Soden; Simon Horslen; Jeffrey A Rudolph; Samuel Kocoshis; Riccardo Superina; Sharon Lawlor; Tamara Haller; Marcia Kurs-Lasky; Steven H Belle Journal: J Pediatr Date: 2012-05-11 Impact factor: 4.406
Authors: Prathima Nandivada; Lorenzo Anez-Bustillos; Alison A O'Loughlin; Paul D Mitchell; Meredith A Baker; Duy T Dao; Gillian L Fell; Alexis K Potemkin; Kathleen M Gura; Ellis J Neufeld; Mark Puder Journal: Am J Surg Date: 2016-12-01 Impact factor: 2.565
Authors: Eric A Sparks; Faraz A Khan; Jeremy G Fisher; Brenna S Fullerton; Amber Hall; Bram P Raphael; Christopher Duggan; Biren P Modi; Tom Jaksic Journal: J Pediatr Surg Date: 2015-10-23 Impact factor: 2.545