Peritoneal drainage, laparotomy cuts mortality in NEC

(HealthDay)—For infants with necrotizing enterocolitis (NEC), peritoneal drainage followed by laparotomy is associated with reduced mortality but increased costs compared with peritoneal drainage alone, according to a study published online April 13 in Pediatrics.

Anne Stey, M.D., from Mount Sinai Medical Center in New York City, and colleagues compared total in-hospital cost and mortality for infants undergoing surgical approaches for NEC between 1999 and 2007. Successful propensity-score matching was performed with 699 infants (101 underwent peritoneal drainage; 172 underwent peritoneal drainage followed by laparotomy; and 426 underwent laparotomy).

The researchers found that for peritoneal drainage followed by laparotomy, the average adjusted cost was $398,173, compared with $276,076 for peritoneal drainage (P = 0.004) and $341,911 for laparotomy (P = 0.08). The highest adjusted mortality was seen after peritoneal drainage (56 percent), compared with 35 and 29 percent, respectively, for peritoneal drainage followed by laparotomy and laparotomy (P = 0.01 and P < 0.001). Mortality was similar for peritoneal drainage and laparotomy.

"These findings imply that economic analyses of prospectively gathered cost data are needed to determine not only which intervention has the best outcomes but the highest value," the authors write.

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