Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

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.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.