Variation in practice patterns and resource utilization surrounding management of intussusception at freestanding Children's Hospitals

PurposeTo characterize variation in practice patterns and resource utilization associated with the management of intussusception at Children's Hospitals.MethodsA retrospective cohort study (1/1/09–6/30/11) of 27 Children's Hospitals participating in the Pediatric Health Information System database was performed. Hospitals were compared with regard to their rates of operative management following attempted enema reduction, prophylactic antibiotic utilization, same-day discharge for those successfully managed non-operatively, 48-h readmission rates, and case-related cost and charges.Results2544 patients were identified (median: 93 cases/center) with a median age of 17 months. The rate of operation following attempted enema reduction varied significantly across hospitals (overall rate: 21.1%: range: 11%–62.8%; p < 0.0001). For patients managed non-operatively, significant variability was found for prophylactic antibiotic utilization (overall rate: 23.3%; range: 1.4%–93.2%; p < 0.0001), same-day discharge (overall rate: 15.2%; range: 0%–83.8%; p < 0.0001), readmission rates (overall rate: 17.5%; range: 5.3%–32.1%; p < 0.0001), treatment-related costs (overall median: $2490; range: $829–$5905; p < 0.0001), and charges (overall median: $6350; range: $2497–$10,306; p < 0.0001). Variability in costs and charges was even greater when analyzing all patients (operative and non-operative) with intussusception (overall cost median: $2865; range: $1574–$6763; p < 0.0001; overall charge median: $7110; range: $3544–$22,097; p < 0.0001).ConclusionSignificant variation in practice patterns and resource utilization exists between Children's Hospitals in the management of intussusception. Prospective analysis of practice variation and appropriately risk-adjusted outcomes through a collaborative quality-improvement platform could accelerate the dissemination of best-practice guidelines for optimizing cost-effective care.