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Income disparities in nationwide outcomes of malrotation with midgut volvulus

Published:November 09, 2022DOI:https://doi.org/10.1016/j.jpedsurg.2022.10.049

      Abstract

      Background

      Malrotation with midgut volvulus is a surgical emergency commonly encountered in pediatric surgical practice. Outcomes are excellent with timely diagnosis and treatment, but the development of bowel ischemia is associated with many negative consequences.

      Methods

      The Nationwide Readmissions Database was used to identify patients 0–18 years (excluding newborns) with malrotation and midgut volvulus from 2010 to 2014. Demographics, procedures, and outcomes were compared by income group (highest quartile vs. lowest quartile) using standard statistical tests. Results were weighted for national estimates.

      Results

      Emergency surgery for midgut volvulus was performed in 572 patients. The majority (86%) underwent Ladd's procedure, while 14% required bowel resection and/or ostomy. Patients in the lowest income quartile were more likely to require bowel resection (18% vs. 8%, p = 0.03) or ostomy (9% vs. 2%, p = 0.015) compared to those in the highest income quartile. Low-income patients were more likely to experience prolonged hospital stay (8 [5-13] days vs. 6 [4-8] days, p<0.001) and experience complications including infections (19% vs. 5%, p = 0.002), endotracheal intubation (18% vs. 4%, p<0.001), and blood transfusions (13% vs. 3%, p = 0.003).

      Conclusion

      Income disparity represents a major factor in surgical outcomes in children with midgut volvulus. A broad spectrum of clinical outcomes following surgery for midgut volvulus exists. Patients from lower-income communities are at significantly higher risk for numerous complications, negative outcomes, and higher resource utilization. These findings support additional investigations of practices to mitigate risk for low-income patients.

      Level of evidence

      Level III: Retrospective comparative study

      Keywords

      Abbreviations:

      TPN (total parenteral nutrition), ED (emergency department), NRD (Nationwide Readmissions Database), HCUP (Healthcare Cost and Utilization Project)
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      References

        • Stehr W.
        Intestinal rotation anomalies.
        in: Hirschl PD, RR Waldhausen JJ Pediatric surgery nat. American Pediatric Surgical Association, 2021
        • Coste A.H.
        • Anand S.
        • Nada H.
        • Ahmad H.
        Midgut volvulus.
        StatPearls, Treasure Island (FL)2021
        • Hsiao M.
        • Langer J.C.
        Surgery for suspected rotation abnormality: selection of open vs laparoscopic surgery using a rational approach.
        J Pediatr Surg. 2012; 47: 904-910
        • Le C.K.
        • Nahirniak P.
        • Anand S.
        • Cooper W.
        Volvulus.
        StatPearls, Treasure Island (FL)2021
        • Polites S.F.
        • Lautz T.B.
        • Jenkins T.M.
        • Dasgupta R.
        Implications of transfer status on bowel loss in children undergoing emergency surgery for malrotation.
        J Pediatr Surg. 2019; 54: 1848-1853
        • Dekonenko C.
        • Sujka J.A.
        • Weaver K.
        • Sharp S.W.
        • Gonzalez K.
        • St Peter S.D.
        The identification and treatment of intestinal malrotation in older children.
        Pediatr Surg Int. 2019; 35: 665-671
        • Langer J.C.
        Intestinal rotation abnormalities and midgut volvulus.
        Surg Clin North Am. 2017; 97: 147-159
      1. Overview H. Healthcare Cost and Utilization Project (HCUP), www.hcup-us.ahrq.gov/overview.jsp; [accessed August.2021].

        • Healthcare Cost and Utilization Project (HCUP)
        NRD Description of Data Elements.
        2021 ([accessed October 1, 2022)
        • Torres A.M.
        • Ziegler M.M.
        Malrotation of the intestine.
        World J Surg. 1993; 17: 326-331
        • Palleiko B.A.
        • Lynn J.V.
        • Achkar A.H.
        • Hart-Johnson T.
        • Perry M.A.
        • Blackwood R.A.
        Sociodemographic factors associated with adherence to referrals from the Pediatric Emergency Department.
        J Emerg Med. 2020; 58: 594-602
        • Healy J.M.
        • Olgun L.F.
        • Hittelman A.B.
        • Ozgediz D.
        • Caty M.G.
        Pediatric incidental appendectomy: a systematic review.
        Pediatr Surg Int. 2016; 32: 321-335
        • Lukish J.
        • Levitt M.
        • Burd R.S.
        • Kane T.
        • Sandler T.
        More evidence against appendectomy at the time of a Ladd procedure.
        J Pediatr Surg. 2022;
        • Nasir A.A.
        • Abdur-Rahman L.O.
        • Adeniran J.O.
        Outcomes of surgical treatment of malrotation in children.
        Afr J Paediatr Surg. 2011; 8: 8-11
        • Murphy F.L.
        • Sparnon A.L.
        Long-term complications following intestinal malrotation and the Ladd's procedure: a 15 year review.
        Pediatr Surg Int. 2006; 22: 326-329
        • LaPlant M.B.
        • Hess D.J.
        A review of racial/ethnic disparities in pediatric trauma care, treatment, and outcomes.
        J Trauma Acute Care Surg. 2019; 86: 540-550
        • Rabbitts J.A.
        • Groenewald C.B.
        Epidemiology of pediatric surgery in the United States.
        Paediatr Anaesth. 2020; 30: 1083-1090
        • Rees C.A.
        • Monuteaux M.C.
        • Raphael J.L.
        • Michelson K.A.
        Disparities in pediatric mortality by neighborhood income in United States Emergency Departments.
        J Pediatr. 2020; 219 (209-15 e3)
        • Chang L.
        • Rees C.A.
        • Michelson K.A.
        Association of socioeconomic characteristics with where children receive emergency care.
        Pediatr Emerg Care. 2020;
        • Wang L.
        • Haberland C.
        • Thurm C.
        • Bhattacharya J.
        • Park K.T.
        Health outcomes in US children with abdominal pain at major emergency departments associated with race and socioeconomic status.
        PLoS ONE. 2015; 10e0132758
        • Smink D.S.
        • Fishman S.J.
        • Kleinman K.
        • Finkelstein J.A.
        Effects of race, insurance status, and hospital volume on perforated appendicitis in children.
        Pediatrics. 2005; 115: 920-925
        • Zwintscher N.P.
        • Steele S.R.
        • Martin M.J.
        • Newton C.R.
        The effect of race on outcomes for appendicitis in children: a nationwide analysis.
        Am J Surg. 2014; 207 (discussion 53): 748-753
        • Vaillancourt R.
        • Cameron J.D.
        Health literacy for children and families.
        Br J Clin Pharmacol. 2021;
        • Kennedy B.R.
        • Mathis C.C.
        • Woods A.K.
        African Americans and their distrust of the health care system: healthcare for diverse populations.
        J Cult Divers. 2007; 14: 56-60