Disparities in Utilization of Laparoscopic Colectomies in Pediatric Crohn's Disease
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Read the article on jpedsurg.org ↗Article · Jan 2022 · 1 min read
In brief
In brief
This national database study of 2,833 pediatric Crohn's disease patients reveals significant disparities in laparoscopic colectomy access based on insurance type and socioeconomic status, with privately insured and higher-income patients more likely to receive minimally invasive surgery. Despite laparoscopy being considered safe, only 58% of cases used this approach, with 30-day and 1-year readmission rates of 9% and 18% respectively.
Written by the GCMD Library team from the article.
Purpose: Pediatric patients with Crohn's disease often require colectomies. The laparoscopic approach is considered safe, but there is little national data on outcomes and readmissions in this population.
Methods: The Nationwide Readmissions Database was queried from 2010-2014 for patients ≤ 18 years who underwent colectomy for Crohn's disease during index admission. Patients were stratified by operative approach: laparoscopic versus open. Outcomes were compared with standard statistical methods.
Results: There were 2833 patients (47% female) who underwent a colectomy via laparoscopic (58%) vs. open (42%) approach. Index admissions were elective 55% of the time. Most operations were right hemicolectomy (86%), followed by total colectomy (8%). Of the study population, 489 (17%) were diverted with an ostomy. Readmission rates at 30 days and 1 year were 9% and 18%, respectively. The most common diagnoses at readmission were intra-abdominal infection (16%), small bowel obstruction (16%), and surgical site infection (9%).
Laparoscopy was more commonly performed during elective admissions (63% vs. 44%), for patient with private insurance (72% vs. 39%), and for patients in the highest income quartile (66% vs. 48% in the lowest income quartile), all p