From the Division of Gastroenterology, Department of Pediatrics.
the Department of Internal Medicine, University of New Mexico, Albuquerque, NM.
J Pediatr Gastroenterol Nutr. 2022 Jul 1;75(1):3-9. doi: 10.1097/MPG.0000000000003449. Epub 2022 May 27.
BACKGROUND/OBJECTIVES: Hirschsprung disease (HD) is associated with significant morbidities including long-term bowel dysfunction. The aim of this study was to update national and regional trends in the inpatient care utilization and epidemiology of HD in the United States between 2009 and 2014 using the National Inpatient Sample (NIS) database.
We identified all pediatric admissions with a diagnosis of HD within the NIS from 2009 through 2014. We analyzed HD discharges with respect to various demographic and clinical factors, specifically trends and group differences in inflation-adjusted cost of hospitalization, procedures, co-morbidities, hospital mortality, and length of stay (LOS). A modified Cochrane-Armitage trend test was used to analyze trends for dichotomous outcome variables, and regression analyses were conducted for continuous and binary variables.
National estimates of HD-discharges showed no significant trend between 2009 and 2014 ( P = 0.27), with estimated relative incidence ranging from 46 to 70 per 100,000 pediatric discharges. Inflation-adjusted cost of hospitalization increased by $1137 (SE $326) per year ( P = 0.0005). Pull-through procedures in neonatal age group increased from 33.0% in 2009 to 36.5% in 2014 ( P = 0.003). Hospital mortality has remained stable between 0.4% and 1.0% ( P = 0.598). LOS decreased by 0.23 days per year ( P = 0.036).
Increasing cost of HD-related hospitalization despite decreasing LOS was observed in this cohort. Stable rate of hospitalizations with increasing proportions of pull-through procedures among neonates was noted. Future studies and development of protocols to standardize patient care could improve outcomes and healthcare spending.
背景/目的：先天性巨结肠（HD）与包括长期肠道功能障碍在内的多种严重并发症相关。本研究旨在使用国家住院患者样本（NIS）数据库，更新 2009 年至 2014 年美国 HD 住院患者医疗利用情况和流行病学的国家和地区趋势。
我们从 NIS 中确定了 2009 年至 2014 年间所有被诊断为 HD 的儿科住院患者。我们分析了 HD 出院患者的各种人口统计学和临床因素，具体包括住院费用、手术、合并症、院内死亡率和住院时间（LOS）的通胀调整情况，以及趋势和组间差异。采用改良 Cochrane-Armitage 趋势检验分析二分类结局变量的趋势，对连续和二分类变量进行回归分析。
全国范围内 HD 出院患者人数在 2009 年至 2014 年之间没有显著变化（P=0.27），估计发病率在每 10 万儿科出院患者中有 46 至 70 例。每年的住院费用增加了 1137 美元（SE 326 美元）（P=0.0005）。新生儿年龄组的经肛拖出术比例从 2009 年的 33.0%增加到 2014 年的 36.5%（P=0.003）。院内死亡率在 0.4%至 1.0%之间保持稳定（P=0.598）。每年 LOS 减少 0.23 天（P=0.036）。
尽管 LOS 有所下降，但本研究队列中仍观察到与 HD 相关的住院费用增加。在新生儿中，经肛拖出术的比例增加，住院率保持稳定。未来的研究和制定标准化患者护理的方案可以改善结果和医疗保健支出。
