The impact of hospital type and experience on the operative utilization in pediatric intussusception: a nationwide study

Abstract

Purpose To determine the impact in clinical outcomes of pediatric idiopathic intussusceptions from hospital experience and designation as children's hospitals (CH) and non–children's hospitals (NCH) in the US. Methods A retrospective study was performed on 1263 children with idiopathic intussusception, 2 months to 3 years of age in 2000 and 2003 by extracting data from the Healthcare Cost and Utilization Project Kid's Inpatient Database. Main outcome measures were utilizations of operation and radiologic reduction. Statistical significance was defined as P < .05. Results The median hospital volume of intussusceptions was higher at CH (2.5 vs 0.5 cases per year, P < .001) compared to NCH. Children treated at CH had lower risk of operation (55 vs 68%, P < .001) and higher likelihood of radiologic reduction (39 vs 26%, P < .001) compared to NCH. Multivariate regression analysis showed a 17% reduction of operative utilization at CH vs NCH. Outcomes were positively related to experience as high-volume hospitals reduced operative utilization by 19%. Rates of successful radiologic reduction were similar between hospital types, which was 85% nationally. Conclusion Children with intussusception have decreased likelihood of operation when treated at CH compared to NCH. This decreased operative utilization can be attributed to the increased experience and utilization of radiologic reduction at these specialty hospitals.