Risk factors for hospitalization among pediatric intestinal failure patients Open Access

Hofmekler, Tatyana (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/ff365621b?locale=en
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Abstract

Children with intestinal failure are dependent on parenteral nutrition received through a central venous catheter. Complications due to underlying disease, parenteral nutrition, complications associated with central venous access such as vascular catheter associated infections (VCAIs), predispose patients to hospitalizations. Hospitalizations are poor prognostic indicators and contribute to high costs. Our aim was to identify demographic, social, and medical factors that contribute to hospitalization of children who received their medical care in a multidisciplinary intestinal rehabilitation clinic (IROC), with the long-term goal of focusing resource allocation on identified modifiable risk factors. We conducted a retrospective single center cohort study of children enrolled in IROC clinic. The primary outcome was total number of hospitalizations during follow-up time. Secondary outcomes included length of stay and risk of first hospitalization. As bloodstream infections lead to hospitalizations, we also studied the relationship of VCAIs and the number of hospitalizations. Forty-seven patients had 310 hospitalizations with a median duration of 4 days (1-84) per hospitalization. Results from unadjusted negative binomial models suggest that number of VCAIs (IRR 1.22 (1.06-1.42)) and therapy for small bowel bacterial overgrowth (IRR 1.92 (1.00-3.67)) were significant individual risk factors for number of hospitalizations. Social and demographic factors such as race (IRR 1.03 (0.53-1.99)), age at referral (1.00 (0.99-1.01)), and maternal age at delivery (0.96 (0.90-1.02)) were not risk factors for predicting number of hospitalizations. Survival analysis showed that presence of a colon, an ileocecal valve and short bowel syndrome diagnosis were individually protective against the risk of first hospitalization. Twenty-one (45%) children did not have a recognized VCAI during the study period, although VCAI rate and number of hospitalizations were positively correlated (Pearson correlation coefficient=0.54) among children who had a VCAI. In our single-center cohort of children enrolled in a subspecialty clinic, social and demographic factors were not found to be risk factors for hospitalization while anatomical factors were found to be protective against hospitalization frequency. Receipt of care in a multidisciplinary clinic likely reduced the impact of traditional social and demographic risk factors associated with hospitalization and VCAI, justifying resource allocation to a multidisciplinary subspecialty care clinic environment.

Table of Contents

TABLE OF CONTENTS

Introduction...1

Background...3

Methods..5

Results...11

Discussion/Conclusions...14

References...19

Figure 1: Overall analytic plan...21

Table 1: Patient baseline characteristics of pediatric patients with intestinal failure...22

Figure 2: Distribution of hospitalization count and hospitalization days...24

Table 2: Hospitalization incident rate ratios of demographic, social and medical characteristics...25

Figure 3: Multivariate model of risk factors on incident rate ratio for hospitalization count and vascular catheter associated infections ...27

Figure 4: Survival plots of small bowel bacterial overgrowth therapy, colon presence, short gut diagnosis, and ileocecal valve presence to the first hospitalization ...28

Table 3: Cox proportion hazard model of risk to first hospitalization for small bowel bacterial overgrowth therapy, small bowel length, ileocecal valve presence, short gut diagnosis, or having any colon ...30

Table 4: Vascular catheter associated infection count and rate for all pediatric intestinal failure patients ...31

Figure 5: Correlation of vascular catheter associated infections to hospitalizations in pediatric intestinal failure patients...32

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