TY - JOUR
T1 - Temporal trends of splenectomy in pediatric hospitalizations with immune thrombocytopenia
AU - Bhatt, Neel S.
AU - Bhatt, Parth
AU - Donda, Keyur
AU - Dapaah-Siakwan, Fredrick
AU - Chaudhari, Riddhi
AU - Linga, Vijay Gandhi
AU - Patel, Bhumi
AU - Lekshminarayanan, Anusha
AU - Bhaskaran, Smita
AU - Zaid-Kaylani, Samer
AU - Badawy, Sherif M.
N1 - Funding Information:
We derived our study cohort from the Nationwide Inpatient Sample (NIS) database from years 2005–2014; which is part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ). NIS is a database of hospital inpatient stays derived from billing data submitted by hospitals to statewide data organizations across the United States. These inpatient data include clinical and resource use information typically available from discharge abstracts. The NIS covers all encounters, including those covered by Medicare, Medicaid, private insurance, and the uninsured. The NIS is a 20% stratified sample of discharges from across U.S. community hospitals, excluding rehabilitation and long-term acute care hospitals. The 2014 NIS sampling frame is comprised of 44 states and the District of Columbia, covering more than 96% of the U.S. population.17 NIS is published yearly and contains data of approximately 7 million unweighted hospitalizations per year, which estimates approximately 35 million weighted national hospitalizations. NIS recommends using weighted numbers in order to obtain national estimates. We used the weights provided by the NIS to generate national estimates.18 As ITP-related outcomes, such as severe bleeding (e.g., intracranial bleed) and/or use of second-line treatment modalities, including splenectomy, are rare in children, NIS is well suited to study such populations given the large sample size of this database.
Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2018/7
Y1 - 2018/7
N2 - Background: Splenectomy is considered an effective treatment for immune thrombocytopenia (ITP) with 70–80% response rate. However, its current use is limited in children with ITP. It is unclear if the rates of splenectomy have changed over time. Using a large nationally representative database, we aimed to study the trends of splenectomy in pediatric hospitalizations with ITP, and the factors associated with splenectomy during these encounters. Methods: Using National (Nationwide) Inpatient Sample (NIS), and international classification of diseases (9th revision), clinical modification (ICD-9-CM) codes, we studied pediatric ITP hospitalizations with occurrence of total splenectomy between 2005 and 2014. Results: Out of 37,844 weighted ITP hospitalizations from 2005 to 2014; total splenectomy was performed in 954 encounters. Splenectomy rate declined over time (3.4% [2005–2006] to 1.6% [2013–2014], P < 0.001) with the younger age (≤5 years) having the most notable decline (0.91% [2005–2006] to 0.14% [2013–2014], P < 0.001). Splenectomy had higher odds of being performed electively than non-electively (odds ratio [OR]: 19.34, 95% confidence interval [CI]: 12.06–31.02, P < 0.001). Encounters with intracranial bleed were associated with the occurrence of splenectomy (OR: 17.87, 95% CI: 5.07–62.97, P < 0.001). Intracranial bleed (P < 0.001), gastrointestinal bleed (P < 0.01), sepsis (P < 0.001), and thrombosis (P < 0.001) were associated with longer length of stay and higher cost of hospitalization. Conclusions: Overall, splenectomy rates consistently declined over time. Intracranial hemorrhage during hospitalizations with ITP was associated with occurrence of splenectomy. Future studies should continue to reevaluate the rates of splenectomy in pediatric ITP in the presence of various second-line pharmacologic agents.
AB - Background: Splenectomy is considered an effective treatment for immune thrombocytopenia (ITP) with 70–80% response rate. However, its current use is limited in children with ITP. It is unclear if the rates of splenectomy have changed over time. Using a large nationally representative database, we aimed to study the trends of splenectomy in pediatric hospitalizations with ITP, and the factors associated with splenectomy during these encounters. Methods: Using National (Nationwide) Inpatient Sample (NIS), and international classification of diseases (9th revision), clinical modification (ICD-9-CM) codes, we studied pediatric ITP hospitalizations with occurrence of total splenectomy between 2005 and 2014. Results: Out of 37,844 weighted ITP hospitalizations from 2005 to 2014; total splenectomy was performed in 954 encounters. Splenectomy rate declined over time (3.4% [2005–2006] to 1.6% [2013–2014], P < 0.001) with the younger age (≤5 years) having the most notable decline (0.91% [2005–2006] to 0.14% [2013–2014], P < 0.001). Splenectomy had higher odds of being performed electively than non-electively (odds ratio [OR]: 19.34, 95% confidence interval [CI]: 12.06–31.02, P < 0.001). Encounters with intracranial bleed were associated with the occurrence of splenectomy (OR: 17.87, 95% CI: 5.07–62.97, P < 0.001). Intracranial bleed (P < 0.001), gastrointestinal bleed (P < 0.01), sepsis (P < 0.001), and thrombosis (P < 0.001) were associated with longer length of stay and higher cost of hospitalization. Conclusions: Overall, splenectomy rates consistently declined over time. Intracranial hemorrhage during hospitalizations with ITP was associated with occurrence of splenectomy. Future studies should continue to reevaluate the rates of splenectomy in pediatric ITP in the presence of various second-line pharmacologic agents.
KW - NIS
KW - immune thrombocytopenia
KW - inpatient utilization
KW - national inpatient sample
KW - nationwide inpatient sample
KW - splenectomy
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U2 - 10.1002/pbc.27072
DO - 10.1002/pbc.27072
M3 - Article
C2 - 29637697
AN - SCOPUS:85045118579
SN - 1545-5009
VL - 65
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 7
M1 - e27072
ER -