Hospital differences in short-term outcomes for uncomplicated pediatric patients with gallbladder disease

Howard C Jen, Stephen B Shew
Journal of Surgical Research 2009 May 15, 153 (2): 195-200

PURPOSE: To examine the differences in short-term outcomes and laparoscopic cholecystectomy rates between children's hospitals and non-children's hospitals for uncomplicated pediatric gallbladder disease.

METHODS: A retrospective study was performed of cholecystectomy patients aged 4 to 12 years in 2003 from the Kid's In-Patient Database. Patients with significant comorbidities were excluded. We compared length of hospitalization, complication rates, and laparoscopic cholecystectomy utilization between hospital types.

RESULTS: Five-hundred fifty-six cholecystectomies were performed for children aged 4 to 12 years in 2003 after exclusion. Children's hospital patients had longer hospitalizations (3.34 versus 2.52 days, P < 0.001), and more complications (3.4 versus 0.9%, P = 0.05) despite fewer emergency admissions. Utilization of laparoscopic cholecystectomy was lower at children's hospitals (91 versus 97% P < 0.005). After excluding sickle cell patients, children's hospitals patients still had lower laparoscopic cholecystectomy rates (89 versus 97%, P < 0.005) and longer hospitalizations (3.12 versus 2.44 days, P < 0.01). Hospital and surgeon volumes were not associated with better outcomes. Factors associated with longer hospitalization included treatment at children's hospitals, nonelective admission, sickle cell disease, and complications (P < 0.001).

CONCLUSION: Children without significant comorbidities have longer hospitalizations when treated at children's hospitals for cholecystectomies compared with those at non-children's hospitals. Laparoscopic cholecystectomy use was lower at children's hospitals and similar differences in outcomes remained when comparing only laparoscopic cholecystectomy patients.

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