Minimizing Procedures and Length of Stay in a Pediatric Colorectal Center

Marc Levitt
Marc Levitt, MD, section chief of the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital and senior author of the study.

PediatricsOnline 

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A collaborative, multidisciplinary colorectal center may theoretically benefit patients, but logistical hurdles – sharing resources among divisions or routinely scheduling several surgical disciplines for a single case – often dissuade institutions from creating such a program.

A recent study from the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital, however, demonstrates that the benefits aren’t theoretical at all; in fact, children who undergo combined procedures in this setting have fewer overall surgical interventions, reduced anesthetic procedures, fewer intubations and a shorter length of stay.

“We knew we could improve the experience for families, because we could give them much of the care a child needed at one time, instead of spreading it over months or years,” says Marc Levitt, MD, section chief of the center and senior author of the study. “This study puts numbers behind it. If you are trying to create a health care system that improves care and allows for less expensive care, this is the descriptive model showing why this system works.”

The study, published in Frontiers in Surgery, considers 82 patients (median age 3 years) who underwent 132 combination procedures in 2015. A total of 87 procedures were urological, gynecological and colorectal, and the remainder were either urological and colorectal or gynecological and colorectal.

The great majority of procedures were combined specifically to save an anesthetic, to reduce visits to the hospital or for another practical advantage. In some cases, though, the procedures were combined to allow for a single entrance to the pelvis when correcting complex malformations. Combined procedures also allowed for tissue sharing, such as using resected sigmoid colons for bladder augmentation and using the appendix for urologic and colorectal access. (An illustrated example of similar tissue sharing in the center can be found here).

The median number of anesthetic events per patient was 1 vs. 3 if procedures had been performed individually. Median length of stay in days for patients who required hospitalization was 8 vs. 10. Median number of intubations was 1 vs. 2.

The Center for Colorectal and Pelvic Reconstruction published another study in 2018 laying out exactly how the center itself is structured, from initial patient intake through long-term follow up and transitional care. So Dr. Levitt and his colleagues in Urology, Gynecology and Gastroenterology at Nationwide Children’s have now not only shown how to create a center, but that it can be successful.

“I want other centers to recognize that this is worth doing, and now they have a template,” says Dr. Levitt. “We’re all in this to help patients and their families, and a multidisciplinary center like ours is an important way to do it.”  

References:

Vilanova-Sánchez A, Reck CA, Wood RJ, Garcia Mauriño C, Gasior AC, Dyckes RE, McCracken K, Weaver L, Halleran DR, Diefenbach K, Minzler D, Rentea RM, Ching CB, Jayanthi VR, Fuchs M, Dajusta D, Hewitt GD, Levitt MA. Impact on Patient Care of a Multidisciplinary Center Specializing in Colorectal and Pelvic Reconstruction. Frontiers in Surgery. 2018 Nov 19; 5:68.

Vilanova-Sanchez A, Halleran DR, Reck-Burneo CA, Gasior AC, Weaver L, Fisher M, Wagner A, Nash O, Booth K, Peters K, Williams C, Brown SM, Lu P, Fuchs M, Diefenbach K, Leonard JR, Hewitt G, McCracken K, Di Lorenzo C, Wood RJ, Levitt MA. A descriptive model for a multidisciplinary unit for colorectal and pelvic malformations. Journal of Pediatric Surgery. 2018 Apr 19