Epidemiology and healthcare utilization of inpatient admissions in children with pediatric intestinal pseudo‐obstruction

Abstract

Background Pediatric intestinal pseudo‐obstruction is a rare disorder affecting gastrointestinal motility leading to chronic symptoms and hospitalizations. There is limited understanding of the epidemiology and healthcare burden. Methods We analyzed data from Kids' Inpatient Database from 2016, which includes inpatient discharge records from US hospitals. ICD‐10 codes were used to identify patients 0‐18 years with pediatric intestinal pseudo‐obstruction and comorbid conditions. Multivariable logistic regression and Wilcoxon rank‐sum test were used. Results In 2016, there were 1671 inpatient discharges from US hospitals for patients 0‐18 years of age with this diagnosis. The incidence of inpatient admission was 29/100 000 patients. After controlling for age, race, income status, and insurance, males vs females (adjusted odds ratio, aOR: 1.10; 95% CI: 0.94‐1.28; P = .241) and caucasians vs other races (aOR: 1.55; 95% CI: 1.27‐1.88; P < .001) were more likely to be admitted. Inpatient admissions incurred significant healthcare burden; median (inter quartile range IQR) cost of hospitalization of US$ 52 079 (US$ 23 530‐120 961) and a median (IQR) length of stay of 6 days (3‐14 days). Gastrostomy (32%) and ileostomy (12.6%) status appeared to incur lower healthcare burden. Parenteral nutrition, malnutrition, and central line/bloodstream infections resulted in higher healthcare burden. Conclusions Pediatric intestinal pseudo‐obstruction is a rare diagnosis with a high incidence of inpatient admissions and healthcare burden. An aggressive multidisciplinary management is crucial in reducing inpatient admissions in this cohort.

Optimizing nutrition in pediatric intestinal pseudo‐obstruction syndrome

“…Poor nutritional state, inability to achieve normal growth and maintain a normal body weight are observed in up to 72% of PIPO patients and are associated with longer hospital admissions and worse clinical outcome 5,13,14 . As mentioned earlier, the severity of digestive symptoms triggered by food ingestion, abnormal intestinal absorption, and the side effects of medications represent the main contributing factors to undernutrition in PIPO 15 .…”

“…4 Moreover, due to its complexity PIPO is associated with significant healthcare expenditure and utilization. 5 The clinical manifestations of PIPO are extremely variable and influenced by age of onset (i.e., prenatal, neonatal, and late onset disease), location and/or extent as well as severity of GI involvement and phase of the disease (relapse or remission). For instance, during an acute episode of pseudo-obstruction, significant abdominal distension, abdominal pain, vomiting, and inability to tolerate enteral feeding usually dominate the clinical picture.…”

“…PIPO has a significant impact on patient quality of life with considerable psychological and emotional burden for both children and their families 4 . Moreover, due to its complexity PIPO is associated with significant healthcare expenditure and utilization 5 …”

Pediatric Intestinal Pseudo-Obstruction: Progress and Challenges

“…A recent nationwide survey in Japan reported a prevalence of 3.7 in one million children with equal sex incidence ( 7 ). A nationwide study in the United States stated that around 100 infants were born every year with PIPO ( 8 ) and a more recent United States nationwide survey found an incidence of inpatient admission of 29 per 100,000 patients ( 9 ). Even though rare, PIPO inpatient admissions carry a high healthcare burden and the presence of malnutrition, parental nutrition and its complications result in longer duration and higher cost of hospitalization ( 9 ).…”

Pediatric Intestinal Pseudo-Obstruction: An International Survey on Diagnostic and Management Strategies in the European Reference Network for Rare Inherited and Congenital Anomalies Intestinal Failure Teams

“…P ediatric intestinal pseudo-obstruction (PIPO) is a rare heterogeneous group of most severe intestinal motility disorders which can lead to intestinal failure (IF). PIPO has an incidence of less than 1 in 40,000 to 100,000 (1)(2)(3). The diagnosis of PIPO is based on symptoms of chronic and recurrent obstructive symptoms with radiological features of dilated intestine with air-fluid levels in the absence of any occluding lesion (2,4).…”