Details

Autor(en) / Beteiligte

• Oliveira, Carol, MD
• de Silva, Nicole T., MSc
• Stanojevic, Sanja, PhD
• Avitzur, Yaron, MD
• Bayoumi, Ahmed M., MD, MSc
• Ungar, Wendy J., PhD
• Hoch, Jeffrey S., PhD
• Wales, Paul W., MD, MSc, FACS

Titel

Change of Outcomes in Pediatric Intestinal Failure: Use of Time-Series Analysis to Assess the Evolution of an Intestinal Rehabilitation Program

Ist Teil von

• Journal of the American College of Surgeons, 2016-06, Vol.222 (6), p.1180-1188.e3

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background The clinical picture of pediatric intestinal failure has changed over the past 15 years, while effectiveness evolving treatment options remains unclear. The study explores evolution in care and quantifies independent effects of new treatment options. Study Design Consecutive patients (n=196) with neonatal/infantile intestinal failure born between 07/1996 and 12/2011 were derived from an intestinal rehabilitation program (IRP) patient registry. Change over time was analyzed using multivariable Box-Jenkins-method based autoregressive integrative moving average models (ARIMA), robust linear regression and non-parametric trend analysis. Four systematically introduced treatment options (IRP, serial transverse enteroplasty, omega-3 lipid emulsions, ethanol locks) were evaluated. Analyses were adjusted for patient characteristics and disease severity. The primary outcome was disease-specific mortality from liver failure and sepsis. Secondary outcomes included parenteral nutrition weaning, transplantations, catheter complications and liver disease. Results Patient characteristics remained unchanged over time, except for decreasing small bowel length (-0.5%/quarter; 95% Confidence Interval (95%-CI) -0.85, -0.16) and intensive care unit admission time (-0.6 days/quarter; 95%-CI -1.03, -0.18). Disease-specific mortality diminished significantly over time (-0.02 deaths/quarter; 95%-CI -0.03, -0.01) by IRP and omega-3 lipids introduction (-0.6 deaths/quarter each, 95%-CI -1.23, -0.02 and -0.77, -0.45). Serial transverse enteroplasty and ethanol locks did not impact significantly. Parenteral nutrition weaning and transplantations remained unchanged, while catheter sepsis and complication rates decreased by 0.3 episodes/1000 catheter-days each (95%-CI -0.43, -0.2 and -0.45, -0.24). Conclusions Introduction of IRP and omega-3 lipids independently decreased disease-specific mortality. For the first time, time series analysis was applied to evaluate effectiveness of treatment options in intestinal rehabilitation.