Implications of transfer status on bowel loss in children undergoing emergency surgery for malrotation
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Read the article on jpedsurg.org ↗Article · Apr 2019 · 1 min read
In brief
In brief
This multicenter study of 3,373 pediatric malrotation cases reveals that transferred patients face significantly higher bowel resection rates (30.7% vs 16.4%) compared to direct admissions. Transfer delays disproportionately affect younger, premature, nonwhite, and publicly insured children, highlighting critical access disparities in time-sensitive surgical emergencies.
Written by the GCMD Library team from the article.
Objective
Malrotation with midgut volvulus is a time-sensitive pediatric surgical disease that requires emergent operative exploration to avoid bowel loss; however, it also requires specialized pediatric care. The purpose of this study was to identify disparities in bowel resection in children who underwent emergency surgery for malrotation; particularly the role of transfer status.
Methods
The Pediatric Health Information System was used to identify a multicenter cohort of patients who underwent emergency surgical intervention for malrotation. Univariate and multivariable analyses were used to determine factors associated with the primary outcome of bowel resection; secondary outcomes included surgical complications, prolonged length of stay, TPN dependence, and death.
Results
Of 3373 patients with malrotation included, 44.8% were transferred in. Younger age, prematurity and other comorbidity, nonwhite race, and public insurance were associated with transfer. Transferred patients were more likely to undergo bowel resection on univariate (30.7 vs 16.4%, p