Hospital Readmission Rates Among Children With Crohn Disease

Study data published in the Journal of Pediatric Gastroenterology and Nutrition suggest that obesity increases the risk for hospital readmission after intestinal resection among children with Crohn disease (CD). In a longitudinal cohort study of patients who underwent surgery for CD, those with obesity were nearly twice as likely to be readmitted in the month after discharge.

Investigators utilized the National Surgical Quality Improvement Program-Pediatric database to identify pediatric patients with CD who underwent intestinal resection in the United States between 2012 and 2018. The database includes demographic and clinical information for each patient, as well as postsurgery follow-up data.

The primary outcome of the current analysis was 30-day hospital readmission rates. The secondary outcome was postoperative surgical site infection. Logistic regression models were used to identify correlates of these outcomes. Models were adjusted for age, race/ethnicity, sex, steroid exposure, disease activity, and surgery type.

The study cohort included 1258 pediatric patients with CD. Patients were predominantly white (84%) and boys (56%). Most patients were between the ages of 13 and 17 years (91%). The distribution of patients by body mass index (BMI) was as follows: 50% average weight, 31% underweight, 11% overweight, and 8% obese.

A total of 111 patients (8.8%) were readmitted within 30 days of the initial procedures. In adjusted regression models, obesity was associated with a nearly 2-fold increase in readmission rates (odds ratio [OR], 1.9; 95% CI, 1.0-3.8). Sex, age, race, presurgical steroid exposure, and procedure type were not significantly associated with readmission rates.

A total of 112 patients (9%) experienced postoperative surgical site infections, among which 56% were organ space infections. As with readmission rates, patients with obesity were more likely to experience a surgical site infection compared against patients without obesity (OR, 1.8; 95% CI, 0.9-3.5), though the difference was not statistically significant. However, patients with an overweight BMI demonstrated significantly higher risk for infection compared against patients with an average BMI (OR, 2.2; 95% CI, 1.2-4.0).

Results from this analysis suggest that children with obesity may be at greater risk for hospital readmission after CD-related surgery. As far as study limitations, investigators noted the retrospective study design and the lack of preoperative laboratory data, which limited the ability to control for disease activity.

“These results can inform pre-surgical risk counseling and underscore the need for long-term weight management strategies to reduce the risk of post-operative morbidity in obese children with CD who may be at risk of future intestinal surgery,” authors concluded.

Reference

Egberg MD, Galanko JA, Banegas M, et al. Obesity increases the risk of hospital readmission following intestinal surgery for children with Crohn disease. J Pediatr Gastroenterol Nutr. 2021;73(5):620-625. doi: 10.1097/MPG.0000000000003251