Intussusception: Hospital size and risk of surgery

Objective. To determine whether the risk of operative management of childre n with intussusception varies by hospital pediatric caseload. Design. A cohort of all children with intussusception in Washington State f rom 1987 through 1996. Setting. All hospitals in Washington State. Methods. Five hundred seventy children with a hospital discharge diagnosis of intussusception were identified. Sixty-two were excluded because of miss ing data. Procedure codes for operative management and radiologic managemen t were also identified. Results. Fifty-three percent of the children had operative reduction and 20 % had resection of bowel. Children with operative reduction did not differ from those with nonoperative care by median age or gender; however, childre n with operative care were significantly more likely to receive care in hos pitals with smaller pediatric caseloads and to have a coexisting condition associated with intussusception. Sixty-four percent of children who receive d care in a large children's hospital had nonoperative reduction, compared with 36% of children who received care in hospitals with 0 to 3000 annual p ediatric admissions and 24% of children who had care in hospitals with 3000 to 10 000 annual pediatric admissions. Median length of stay and charges w ere significantly less in the large children's hospital, compared with othe r centers. Conclusions. Children who received care for intussusception in a large chil dren's hospital had decreased risk of operative care, shorter length of sta y, and lower hospital charges compared with children who received care in h ospitals with smaller pediatric caseloads.