Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

Abstract

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. 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 $ 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. WHAT'S KNOWN ON THIS SUBJECT:Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated. WHAT THIS STUDY ADDS:After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a costbenefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias.

Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

“…Surgery involves laparotomy (often with intestinal resection) and ostomy creation, with potential long-term health effects and a mortality rate of #50% (27,37,39). Surgical NEC survivors may be affected by shortbowel syndrome or intestinal failure, with attendant failure to thrive and postoperative complications such as intestinal strictures, bowel obstruction, enterocutaneous fistulas, intraabdominal abscess, wound dehiscence, central line sepsis, or poor neurodevelopmental outcomes (14,19,37,(40)(41)(42).…”

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

“…Necrotizing enterocolitis (NEC) is the leading cause of death from gastrointestinal disease in premature infants, affecting newborn babies at a rate of 1–3 per 1000 births per year in North America 1,2 , with an average total treatment cost of US$500,000 per patient in the USA in current charges 3,4 . Importantly, the mechanisms leading to the development of NEC in premature infants and the lessons learned from management of patients with NEC could have broad implications to other neonatal inflammatory processes 5,6 .…”

New Frontiers of Necrotizing Enterocolitis: From Pathophysiology to Treatment

“…Given that up to 74% of infants initially managed with peritoneal drainage will require a subsequent laparotomy [96] [99] a commonly accepted approach has been to reserve primary peritoneal drainage for those patients with substantially elevated intra-abdominal pressure that impairs ventilation, or for extremely small infants under 750 g.…”