Change of Outcomes in Pediatric Intestinal Failure: Use of Time-Series Analysis to Assess the Evolution of an Intestinal Rehabilitation Program Carol.

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Presentation transcript:

Change of Outcomes in Pediatric Intestinal Failure: Use of Time-Series Analysis to Assess the Evolution of an Intestinal Rehabilitation Program Carol Oliveira, MD, PhD, Nicole T. de Silva, MSc, Sanja Stanojevic, PhD, Yaron Avitzur, MD, Ahmed M. Bayoumi, MD, MSc, Wendy J. Ungar, PhD, Jeffrey S. Hoch, PhD, Paul W. Wales, MD, MSc, FACS Journal of the American College of Surgeons Volume 222, Issue 6, Pages 1180-1188.e3 (June 2016) DOI: 10.1016/j.jamcollsurg.2016.03.007 Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 1 Disease-specific mortality, change over time from 1996 to 2011. Disease-specific mortality was stable around 1 death per quarter and dropped with introduction of intestinal rehabilitation program (IRP). Further decrease in mortality was observed after the omega-3 lipids introduction in 2006. STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 2 (A) Parenteral nutrition weaning, change over time from 1996 to 2011. Complete weaning from parenteral nutrition remained unchanged over the 15-year time period. (B) Advanced liver disease, change over time from 1996 to 2011. Increased awareness led to an increase of advanced liver disease shortly after the intestinal rehabilitation program (IRP) introduction. With IRP maturation, progression into advanced liver disease has been increasingly prevented. STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions

Figure 3 Central venous catheter and transplantation related outcomes, change over time from 1996 to 2011. (A and B) Central venous catheter complications and catheter-related bloodstream infections decreased by 0.3 episodes/1,000 catheter-days per quarter. (C and D) Transplant assessments and transplantations followed a similar course to that of advanced liver disease. With increased awareness of liver disease and improved communication with the transplant team during the first 4 years of the intestinal rehabilitation program (IRP), more patients were assessed and received transplants during this time period. Maturation of the intestinal rehabilitation program led to prevention of advanced liver disease, making transplant assessment and transplantation less necessary. STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions

Supplemental Figure 1 Linear trend of disease-specific mortality. Disease-specific mortality decreased from 1 death/quarter to 0 deaths/quarter in average. IRP, intestinal rehabilitation program; STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions

Supplemental Figure 2 Linear trend of parenteral nutrition weaning and advanced liver disease. (A and B) The linear trend of complete weaning from parenteral nutrition and advanced liver disease incidence indicate no significant change over the 15-year time period. IRP, intestinal rehabilitation program; STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions

Supplemental Figure 3 Linear trend of central venous catheter- and transplantation-related outcomes. (A and B) Central venous catheter complications and catheter-related bloodstream infections decreased by 0.3 episodes/1,000 catheter-days per quarter. (C and D) The linear change of transplant assessments and transplantations was not significant. IRP, intestinal rehabilitation program; STEP, serial transverse enteroplasty. Journal of the American College of Surgeons 2016 222, 1180-1188.e3DOI: (10.1016/j.jamcollsurg.2016.03.007) Copyright © 2016 American College of Surgeons Terms and Conditions