P1.080: How has our Approach to Bowel Resection in Pediatric Patients with Crohn Disease Changed over the Last 10 Years: A Review of the NSQIP-Pediatric Database

Background: Many patients with Crohn disease will require surgical intervention in their lifetime. Studies have shown benefits of a laparoscopic approach to bowel resection in adults, including decreased length of hospital stay and fewer complications. Smaller studies have demonstrated similar benefits of laparoscopic surgery in the pediatric population. The goal of this study was to understand how the trends toward an open versus laparoscopic approach to bowel resection in patients with Crohn disease has changed over the last decade and compare post-operative outcomes between the two cohorts.

Methods: Patients between the ages of 3 to 17 years with the diagnosis of Crohn disease who underwent bowel resection between 2014-2023 were identified in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) Database. Using current procedural terminology (CPT) codes and the minimally invasive surgery (MIS) variable in NSQIP, patients were classified as undergoing open or laparoscopic bowel resection. Test for trend over the last decade toward open versus laparoscopic approach was performed using Cochrane-Armitage test. Comparison of 30-day outcomes between the two cohorts was performed using propensity score matched cohorts.

Results: Over the last 10 years, we identified 2,351 pediatric patients who had a bowel resection for Crohn disease, 20% of patients had open surgery, and 80% had laparoscopic surgery. Body mass index percentile was higher in patients undergoing laparoscopic surgery (38.6, interquartile range (IQR) 9.1-72.0) than those undergoing open (29.9, IQR 5.7-65.7) (p = 0.006). Elective cases were more likely to be laparoscopic, while urgent and emergent cases were more likely to be open (p < 0.0001). Patients with American Society of Anesthesiologists (ASA) classification ≥ 3 were more likely to undergo open bowel resection (1.5% vs. 0.6%) (p = 0.048). Over the last 10 years, the percentage of open bowel resections has decreased with a corresponding increase in a laparoscopic approach for patients with Crohn disease (p < 0.0001) (Figure 1). After propensity score matching, the median length of stay in the open cohort (n=418) was 7 days (IQR 5-12) and in the laparoscopic cohort (n=418) was 6 days (IQR 4-10) (p = 0.0002). In the open cohort, there was a higher number of patients who experienced bleeding (total n=30, 7.2%) compared to the laparoscopic cohort (n=14, 3.3%) (p= 0.013). The risk of all other post-operative complications was similar between the matched cohorts (Table 1).

Conclusion: Over the last decade, there has been a significant increase in the percentage of children undergoing laparoscopic bowel resection for management of Crohn disease. A laparoscopic approach in Crohn disease did not increase risks for post-operative complications and was associated with shorter hospital stay and less bleeding complications.