Early discharge after nonoperative management of intussusception is both safe and cost-effective
Copyright © 2021 Elsevier Inc. All rights reserved..
BACKGROUND/PURPOSE: We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates.
METHODS: A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant.
RESULTS: Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6].
CONCLUSIONS: Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions.
LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Retrospective comparative treatment study.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
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| Enthalten in: |
Journal of pediatric surgery - 57(2022), 1 vom: 30. Jan., Seite 147-152 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Arshad, Seyed A [VerfasserIn] |
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| Links: |
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| Themen: |
Cost-effectiveness |
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| Anmerkungen: |
Date Completed 01.02.2022 Date Revised 01.02.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jpedsurg.2021.09.047 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM332946568 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND/PURPOSE: We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates | ||
| 520 | |a METHODS: A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant | ||
| 520 | |a RESULTS: Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6] | ||
| 520 | |a CONCLUSIONS: Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions | ||
| 520 | |a LEVEL OF EVIDENCE: Level III | ||
| 520 | |a TYPE OF STUDY: Retrospective comparative treatment study | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cost-effectiveness | |
| 650 | 4 | |a Intussusception | |
| 650 | 4 | |a Pediatric | |
| 650 | 4 | |a Quality improvement | |
| 650 | 4 | |a Recurrence | |
| 700 | 1 | |a Hebballi, Nutan B |e verfasserin |4 aut | |
| 700 | 1 | |a Hegde, Brittany N |e verfasserin |4 aut | |
| 700 | 1 | |a Avritscher, Elenir B C |e verfasserin |4 aut | |
| 700 | 1 | |a John, Susan D |e verfasserin |4 aut | |
| 700 | 1 | |a Lapus, Robert M |e verfasserin |4 aut | |
| 700 | 1 | |a Tsao, KuoJen |e verfasserin |4 aut | |
| 700 | 1 | |a Kawaguchi, Akemi L |e verfasserin |4 aut | |
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