Outcomes of Acute Care Surgery in Patients with Pervasive Developmental Disorder
Nicholas Druar2, Mitchell Cahan1
1Mount Auburn Hospital, Cambridge, Massachusetts, United States, 2St. Mary's Hospital, Hartford, Connecticut, United States
Objective
There has been an increase in the diagnosis of patients with pervasive developmental disorders (PDD) including autism spectrum disorder over the past twenty years. However, limited literature has examined the surgical outcomes for these patients. Given the wide range of functional status for these patients there is a higher likelihood for delay of care due to an inability to express themselves. The aim here was to understand outcomes for these patients related to acute care surgical diagnoses.
Design
Retrospective database study
Setting
Data from National Inpatient Sample database
Patients
The National Inpatient Sample from 2016-2019 was queried for patients with a diagnosis consistent with the need for acute care surgical services based on the International Classification of Disease tenth edition (ICD-10) including cholecystitis, cholangitis, pancreatitis, acute appendicitis, hemoperitoneum, gastric perforation, duodenal perforation, complicated diverticular disease, and necrotizing soft tissue infections. Patients were classified as either having a diagnosis of PDD or not based on ICD-10. Patients were excluded if they were less than 18 or if the admission was considered elective.
Interventions
Patients with and without a diagnosis of PDD were compared to understand differences in morbidity and mortality.
Main Outcome Measure(s)
The main outcome measure was mortality of patients with and without PDD
Results
There were a total of 696,273 patients with an acute care surgery diagnosis. 773 (0.1%) patients within this group also had a diagnosis of pervasive developmental disorder (PDD). Patients with PDD were younger (mean 34.6) compared to patients without PDD (54.9, p<0.001). Patients were more likely to stay longer in the hospital (mean 9 versus 6 days, p<0.001) and have a higher cost of admission (mean $101,218.8 versus $74,491.1, p<0.001). There were 25 (3.2%) deaths in the PDD group compared to 22,849 (3.3%) in the non-PDD group (p=0.9). Patients in the PDD group were more likely to have a respiratory complication with an odds ratio of 1.7 (1.4-2, p=<0.001), Gastrointestinal complication 1.5 (1.1-2.1, p=0.01) and Infection following procedure 1.9 (1.0-3.2, p=0.02). Patients with PDD were also more likely to have a non-routine discharge (odds ratio 1.4 (1.2-1.6, p<0.001).
Conclusions
Patients admitted for acute care surgery diagnoses who also carry a diagnosis of a pervasive developmental disorder (PDD) are at an increased risk for complications. Practitioners should have an increased index of suspicion for patients with PDD. Further institutional studies are need to examine the underlying reasons for these disparities.
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