Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Published in: Pediatrics, v. 135, no. 5, May 2015, p. e1190-e1197

Posted on RAND.org on April 24, 2015

by Anne M. Stey, Elizabeth S. Barnert, Chi-Hong Tseng, Emmett B. Keeler, Jack Needleman, Mei Leng, Lorraine I. Kelley-Quon, Stephen B. Shew

Read More

Access further information on this document at Pediatrics

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND AND OBJECTIVES: Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score-matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC. METHODS: Utilizing the California OSHPD Linked Birth File Dataset, 1375 infants with surgical NEC between 1999 and 2007 were retrospectively propensity score matched according to intervention type. Total in-hospital costs were converted from longitudinal patient charges. A multivariate mixed effects model compared adjusted costs and mortality between groups. RESULTS: Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was $398 173 (95% confidence interval [CI]: 287 784-550 907), which was more than for peritoneal drainage ($276 076 [95% CI: 196 238-388 394]; P = .004) and similar to laparotomy ($341 911 [95% CI: 251 304-465 186]; P = .08). Adjusted mortality was highest after peritoneal drainage (56% [95% CI: 34-75]) versus peritoneal drainage followed by laparotomy (35% [95% CI: 19-56]; P = .01) and laparotomy (29% [95% CI: 19-56]; P < .001). Mortality for peritoneal drainage was similar to laparotomy. CONCLUSIONS: Propensity score–matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.