2013 - ISBTS 2013 Symposium


Oral Communications 1

7.211 - Change of outcome in pediatric intestinal failure – the use of time series analysis to assess the evolution of an intestinal rehabilitation program

Presenter: Carol, Oliveira, , Canada
Authors: Carol Oliveira1,2,3,5, Nicole de Silva1,2, Sanja Stanojevic3,5, Yaron Avitzur1,4, Ahmed Bayoumi5, Wendy Ungar3,5, Jeffrey Hoch5, Paul Wales1,2,3,5


Change of outcome in pediatric intestinal failure – the use of time series analysis to assess the evolution of an intestinal rehabilitation program

Carol Oliveira1,2,3,5, Nicole de Silva1,2, Sanja Stanojevic3,5, Yaron Avitzur1,4, Ahmed Bayoumi5, Wendy Ungar3,5, Jeffrey Hoch5, Paul Wales1,2,3,5

1Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, ON, Canada; 2Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; 3Department of Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Toronto, ON, Canada; 4Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada; 5Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada

 

Background: The paradigm of pediatric intestinal failure management has changed during the last decade. The objective of this study was to explore this process and quantify the independent effect of new treatment options.
Methods: Patients were derived from the prospective registry of our intestinal rehabilitation program (IRP).  Change over time was analyzed using multivariate Box-Jenkins-method based autoregressive integrative moving average models (ARIMA), which allow accounting for time delay of exposure and effect. Model selection was driven by clinical reasoning and goodness-of-fit. Post-estimation assessment of residuals and over-fitting was performed. Quarterly time periods were applied. Secondary analyses included non-parametric trend and cumulative exposure analysis.
Results: 196 patients with neonatal/infantile short bowel syndrome born between 07/1996 and 12/2011 were identified. Disease-specific mortality from liver failure and sepsis decreased significantly (p<0.001; Figure). Introduction of IRP and Omega-3 lipid emulsions were independently associated with decreased disease-specific mortality by 68.6% and 42.4% (p<0.001; p<0.001) when adjusted for small bowel length, gestational age and development of intestinal failure associated liver disease (IFALD). Gestational age and IFALD were significant predictors of disease-specific mortality (-95% risk per gestational week, p<0.001; 9.3% risk increase, p<0.001). Other mortality was unchanged and affected by IFALD only (24.6% risk increase, p=0.001). Parenteral nutrition weaning remained stable and was increased by 2.3% per 1% of small bowel and 62.5% with IFALD (p<0.001; p<0.001). Development of IFALD was predicted by persistent conjugated bilirubin >50µmol/L and male sex (51.4%, p<0.001; 24.8%, p=0.007). Progression into liver failure, sepsis and catheter complication rates decreased significantly over time (p=0.001; p<0.001; p<0.001).
Conclusions: Introduction of IRP and Omega-3 lipid emulsions independently decreased disease-specific mortality when adjusted for disease severity and progression. For the first time, time series analysis was applied to evaluate the independent impact of treatment options on patient outcomes over the evolution of an intestinal rehabilitation program.


You must be logged in to view recordings

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Our Corporate Sponsors

TTS gratefully acknowledges the Corporate Partners whose generous support makes the work of the Society possible:

  • astellas
  • roche
  • sanofi