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Mortality and Management of Surgical Necrotizing Enterocolitis in the United States
*Melissa A. Hull MD1#, *Jeremy G. Fisher MD1#, *Ivan M. Gutierrez MD1, *Brian A. Jones MD1, *Kuang Horng Kang MD1, *Michael Kenny MA2, *David Zurakowski PhD1, *Biren P. Modi MD1, *Jeffrey D. Horbar MD2, *Tom Jaksic MD, PhD1
1Department of Surgery, Children's Hospital Boston, 2Vermont Oxford Network, Burlington, VT

#Co-First Authors

Objective: To establish national benchmarks for the mortality of surgical NEC and to describe the utilization and associated mortality of laparotomy versus peritoneal drainage.

Design: Retrospective Review from large national multicenter database.

Setting: 585 participating U.S. centers contributing to the Vermont Oxford Database.

PARTICIPANTS: 188,743 VLBW neonates (401-1500g) between January 2006 and December 2010.

Main Outcome Measures: Survival was defined as living in-hospital at one year of age or discharge from hospital.

Results: 17,159 (9%) had NEC with a mortality of 28.2%. 8,224 patients did not receive operations (medical NEC, mortality 21.3%). 8,935 were operated upon (mortality 34.6%). On multivariable regression, lower birth weight, laparotomy, and peritoneal drainage were independent predictors of mortality (P<0.001). In surgical NEC a plateau mortality of around 30% persisted despite birth weights over 750g while medical NEC mortality fell consistently. For example, in neonates weighing 1251-1500g, mortality was 27% in surgical patients versus 6% in medical NEC (odds ratio for death 6.1, 95% CI 4.6-8.1). Of those treated surgically, 6,131(69%) underwent laparotomy only (mortality 31%), 1,283 received drainage and a laparotomy (mortality 33.7%), and 1,521 had drainage alone (mortality 49.6%).

Conclusions: 52% VLBW neonates with NEC underwent surgery, which was accompanied by a substantial increase in mortality. Regardless of birth weight, surgical NEC showed a plateau in mortality at approximately 30%. Laparotomy was the more frequent method of treatment (69%) and of those managed by drainage 46% also had a laparotomy. The laparotomy alone and drainage with laparotomy groups had similar mortalities while the drainage alone treatment cohort was associated with the highest mortality.

*Co-First Authors

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