QS352. Hospital Differences in Short-Term Outcomes for Uncomplicated Pediatric Patients With Gallbladder Disease

Abstract

Background: The incidence of gallbladder disease and the use of laparoscopic cholecystectomy (LC) in pediatric patients have increased over the past 15 years. We hypothesized that dedicated children’s hospitals (CH), inclusive of both free-standing children’s hospitals and children’s hospitals within hospitals, would have better outcomes for various surgical procedures compared to similar pediatric patients treated at non-children’s hospitals (NCH). The purpose of our study was to examine the differences in the short-term outcomes and utilization of LC between CH and NCH for uncomplicated pediatric patients who underwent cholecystectomy for gallbladder disease. Methods: A retrospective study was performed of children 4 to 12 years of age who had a cholecystectomy for gallbladder disease in 2003 by extracting data from the Healthcare Cost and Utilization Project (HCUP) Kid’s Inpatient Database, which consists of 3 million discharge records from 36 states. Hospitals were categorized as CH by NACHRI criteria. Patients with significant comorbidities such as hepatic, intestinal and cardiac anomalies, cancer, trauma, cerebral palsy, chromosomal abnormalities, as well as prior or concurrent intra-abdominal operations for other diagnoses were excluded from the study. Results: There were 853 cholecystectomies performed in children between the ages 4-12 years old from the KID 2003 database. After excluding patients with significant comorbidities, 556 patients were included in the analysis. CH patients (56%) were slightly younger (9.9 vs. 10.6 years, p<0.005), less obese (3.4 vs. 10.7%, p<0.001), more likely to have sickle cell disease (26.7 vs. 6.2%, p<0.0001), and were more often admitted electively (58 vs. 41%, p<0.001) and during the weekday (90.1 vs. 83.7%, p<0.05) compared to NCH patients. Overall, CH patients had longer hospitalizations (3.34 vs. 2.52 days p<0.001), higher hospital charges ($20,125 vs. $17,919 p<0.05), and developed more complications during the operative hospitalization (3.4 vs. 0.9% p=0.05) despite having less emergency admissions. The utilization of LC was lower at CH compared to NCH (91 vs. 97% p<0.005), and LC patients at CH also had longer hospitalizations (3.31 vs. 2.49 days, p<0.001) and higher hospital charges ($20,027 vs. $17,746, p<0.05). The rates of choledocholithiasis, pancreatitis, ERCP, and LC conversion were not different between CH and NCH. Age, length of stay and total charges for open cholecystectomy patients alone were similar between CH and NCH. If sickle cell patients were excluded, CH patients still had lower LC utilization (89% vs. 97%, p<0.005) with longer hospitalization (3.12 vs. 2.44 days, p<0.01). Using multivariate regression analysis, the independent factors associated with longer hospitalization included treatment at CH, non-elective admission, sickle cell disease, and occurrence of complications (p<0.001). Conclusion: Children without significant comorbidities are more likely to have longer hospitalizations and higher charges when treated at CH for gallbladder disease compared to similar children treated at NCH. In addition to a lower use of LC at CH, similar differences in short-term outcomes are evident between CH and NCH when comparing only LC patients. Although complicated pediatric patients are best cared for at a tertiary care CH, there appears to be potential for improvement in short-term outcomes for uncomplicated patients with gallbladder disease treated at CH.