Surgical Interventions During End-of-Life Hospitalizations in Children’s Hospitals
| Autor: | Pirooz Eghtesady, Maraya Camazine, Michael D. Traynor, Thane A. Blinman, Michael L. Nance, Matthew Hall, Sandi Lam, Ryan M Antiel, Chris Feudtner |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Palliative care Adolescent Biopsy MEDLINE Ethnic group Catheterization Prosthesis Implantation Young Adult International Classification of Diseases Asian americans Patient age Ethnicity Humans Medicine Child Retrospective Studies Salvage Therapy Terminal Care medicine.diagnostic_test business.industry Age Factors Infant Newborn Infant Hospitals Pediatric United States Race Factors Hospitalization Child Preschool Surgical Procedures Operative Chronic Disease Pediatrics Perinatology and Child Health Female business End-of-life care Surgical interventions |
| Zdroj: | Pediatrics. 148 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2020-047464 |
| Popis: | OBJECTIVES To characterize patterns of surgery among pediatric patients during terminal hospitalizations in children’s hospitals. METHODS We reviewed patients ≤20 years of age who died among 4 424 886 hospitalizations from January 2013–December 2019 within 49 US children’s hospitals in the Pediatric Health Information System database. Surgical procedures, identified by International Classification of Diseases procedure codes, were classified by type and purpose. Descriptive statistics characterized procedures, and hypothesis testing determined if undergoing surgery varied by patient age, race and ethnicity, or the presence of chronic complex conditions (CCCs). RESULTS Among 33 693 terminal hospitalizations, the majority (n = 30 440, 90.3%) of children were admitted for nontraumatic causes. Of these children, 15 142 (49.7%) underwent surgery during the hospitalization, with the percentage declining over time (P < .001). When surgical procedures were classified according to likely purpose, the most common were to insert or address hardware or catheters (31%), explore or aid in diagnosis (14%), attempt to rescue patient from mortality (13%), or obtain a biopsy (13%). Specific CCC types were associated with undergoing surgery. Surgery during terminal hospitalization was less likely among Hispanic children (47.8%; P < .001), increasingly less likely as patient age increased, and more so for Black, Asian American, and Hispanic patients compared with white patients (P < .001). CONCLUSIONS Nearly half of children undergo surgery during their terminal hospitalization, and accordingly, pediatric surgical care is an important aspect of end-of-life care in hospital settings. Differences observed across race and ethnicity categories of patients may reflect different preferences for and access to nonhospital-based palliative, hospice, and end-of-life care. |
| Databáze: | OpenAIRE |
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