American Surgical Association Home American Surgical Association Annual Meeting
Search Meeting Site Only
Annual Meeting Home
Program
Past & Future Meetings

 

 

Back to Annual Meeting Abstracts


Mortality and Management of Surgical Necrotizing Enterocolitis in the United States
Melissa Hull*, Ivan Gutierrez*, Jeremy Fisher*, Brian A Jones*, Kuang Horng Kang*, Michael Kenny*, David Zurakowski*, Biren Modi*, Jeffrey Horbar*, Tom Jaksic
Children's Hospital Boston, Boston, MA

Objectives:
Necrotizing enterocolitis (NEC) is a leading cause of death in very low birth weight (VLBW) neonates. This study sought to establish national benchmarks for the mortality of surgical NEC and describe the utilization and mortality of laparotomy and peritoneal drainage.
Methods:
585 U.S. centers prospectively evaluated 188,743 VLBW neonates (401-1500g) between January 2006 and December 2010. Survival was defined as being alive in-hospital at one year old or discharge from hospital.
Results:
17,159 (9%) had NEC with mortality 28.2%. 8,224 patients did not receive operations (medical NEC, mortality 21.3%). 8,935 were operated upon (mortality 34.6%). On multivariable regression, lower birth weight, laparotomy, and peritoneal drain were independent predictors of mortality (P<0.05). In surgical NEC a plateau mortality of over 30% persisted despite birth weights over 750 g while medical NEC mortality fell consistently. For example, in neonates weighing 1251-1500g, the mortality was 31.6% in surgical patients versus 6.6% in medical NEC (Odds ratio for death 6.1, 95% CI 4.5-8.1). Of those treated surgically, 6,131(69%) underwent laparotomy only (mortality 31%), and 2,804 had peritoneal drainage (mortality 42%). Of those initially treated with drainage 1,283(46%) had a subsequent laparotomy.
Conclusions:
52% VLBW neonates with NEC required surgery, which was accompanied by a substantial increase in mortality. Regardless of birth weight, surgical NEC showed a plateau in mortality that exceeded 30%. Laparotomy was the more frequent method of treatment (69%) and of those managed by drainage 46% also had a laparotomy. The drainage-treated cohort had the highest mortality.


Back to Annual Meeting Abstracts

 



© 2019 American Surgical Association. All Rights Reserved. Privacy Policy.