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Effect of Hospital Type on Utilization of Laparoscopy in the Evaluation of Penetrating Trauma in Pediatric Patients
Hibbut-ur-Rauf Naseem, MD1, Arianne Train, DO1, David H. Rothstein, MD, MS1,2. 1Department of Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA, 2Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA.

Background: To determine the influence of hospital type on the application of laparoscopy in pediatric patients with penetrating abdominal trauma.

Methods: Retrospective cohort study using the 2012 Kids' Inpatient Database, an administrative sampled database representing over 95% of the U.S. population. We included patients ages 0-18 suffering penetrating trauma due to gunshot wound or stabbing. Patients who did not have an abdominal procedure were then excluded. The main outcome variable was use of laparoscopy and the main exposure variable was hospital type (free-standing vs non-free-standing). Associated variables included patient age, gender, race, severity of illness, payor status, and hospital U.S. region.

Results: An estimated 8,827 patients 0-18 years old suffered penetrating trauma in 2012. Of these, 1,113 had a laparoscopic or open abdominal procedure. The population was 15.8% White and 87.7% male. The median age was 17 years (interquartile range, 16-18) and mean severity of illness was 2.8 (std dev 1.1). On multivariate regression, the use of laparoscopy vs laparotomy for penetrating trauma was more likely at free-standing children's hospitals vs other hospital types (OR 2.6, C.I. 1.2-5.5). Females were also more likely to undergo a laparoscopic approach compared to males (OR 2.8, C.I. 1.5-5.0).

Conclusions: Pediatric patients suffering penetrating abdominal trauma are nearly three times more likely to undergo laparoscopy rather than laparotomy at a free-standing children's hospital compared to other hospital type. Regionalization of pediatric trauma care and further study may broaden the application of minimally invasive techniques in pediatric trauma.

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