J Pediatr Surg. 2020 Aug;55(8):1556-1561. doi: 10.1016/j.jpedsurg.2019.10.012.Epub 2019 Oct 31.

Robert J McLoughlin ¹, Kerri McKie ², Michael P Hirsh ³, Muriel A Cleary ³, Jeremy T Aidlen ³

Author information

• ¹University of Massachusetts Medical School, Department of Surgery, 55 Lake Ave N, Worcester, MA 01655. Electronic address: Robert.McLoughlin@umassmemorial.org.
• ²University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655.
• ³University of Massachusetts Medical School, Department of Surgery, Division of Pediatric Surgery, 55 Lake Ave N, Worcester, MA 01655.

Abstract

Purpose: We examined the impact of comorbidities on length of stay and total hospital charges for children and young adults with Crohn's Disease (CD) undergoing surgery.

Methods: Patients (<21 years) were identified with a diagnosis of CD and an intraabdominal surgery in the Kids' Inpatient Database for the years 2006, 2009 and 2012. Length of stay (LOS) and total hospital charges (THC; USD$) were stratified by anemia, anxiety, depression and nutritional deficiency. National estimates were obtained using case weighting and multivariable linear regression was performed.

Results: We identified 3224 CD admissions with an intraabdominal surgery. The population was predominantly male, non-Hispanic white, and high school aged. There was an increase in LOS and THC for nutritional deficiency in all study years, and for depression and anemia in specific years. Multivariable linear regression revealed a 3.3-5.5 day increase in LOS associated with a comorbid diagnosis of nutritional deficiency. However, no increase in THC was seen for any comorbidity under evaluation.

Conclusions: Behavioral health and, particularly, nutritional status have a significant impact on the care of children and young adults with CD. Nutritional deficiency, anemia, and depression resulted in increased LOS for those undergoing surgery. Improved presurgical management of comorbidities may reduce LOS for these patients.

Level of evidence: III.