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.

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.

Keywords: cost analysis; mortality; necrotizing enterocolitis; prematurity; surgery.

FIGURE 1

Total in-hospital cost according to propensity score–matched treatment group for infants with early mortality, late mortality, or survival. Comparison of least squares mean cost among these groups was performed by using Tukey’s method for multiple comparisons of propensity score–matched cohorts of infants with surgical NEC according to time to outcome. Error bars represent 95% confidence intervals. *P = .02 for peritoneal drainage alone versus peritoneal drainage followed by laparotomy.

FIGURE 2

Cost per day according to propensity score–matched treatment group for infants with early mortality, late mortality, or survival. Comparison of least squares mean cost per day were performed among the treatment groups by using Tukey’s method for multiple comparisons. Error bars represent 95% confidence intervals.