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• W3044936410 abstract "Introduction and objectives Continence enemas for the purpose of bowel management may be delivered via trans-anal retrograde irrigations, and via antegrade conduits including surgical appendicostomy or placement of cecostomy tube (CT). An appreciation of the relative advantages and disadvantages of each antegrade continence enema (ACE) procedure allows clinicians, parents and children to make an informed decision regarding which procedure is most appropriate in individual cases. The objective of this study was to evaluate the differences in in-hospital resource utilization, surgical outcomes and radiation exposure between children undergoing appendicostomy creation and CT placement at our institution. Methods We conducted a retrospective chart review of children undergoing these procedures at our institution over a 10-year period. All patients 0–18 years of age undergoing either procedure for any indication were included. Data on demographics, length of stay (LOS), radiation exposure events (REE), and surgical outcomes were collected. Results One hundred fifteen (63 appendicostomy/52 CT) patients were included. Those undergoing CT placement had significantly increased post-procedural LOS, catheter exchanges and REE compared to those undergoing appendicostomy (see Table). Reported rates of bowel control were similar between the two groups, and there was no significant difference in rates of surgical complications, although each group had unique, procedure-specific complications. Discussion and conclusion Summary Table 1Length of stay, catheter exchanges and radiation exposure metrics. Appendicostomy n = 63 (%) Cecostomy n = 52 (%) p-value Post-operative LOS (days) All patients 2.8 ± 3 5 ± 5 <0.01 Isolated ACE-procedure (n = 38/44) a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. 2.1 ± 1 4.7 ± 4 <0.0001 Outlier excluded (n = 63/44) a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. 2.8 ± 3 4.9 ± 4 <0.0001 Duration of antibiotic therapy Intravenous (all patients) 1.2 ± 1.3 4 ± 13 0.02 Total (all patients) 2.7 ± 5 5 ± 13 0.16 Intravenous(isolated-ACE a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. ) 0.9 ± 0.9 2 ± 3 0.28 Total (isolated-ACE a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. ) 1.7 ± 3.5 2.6 ± 4 0.46 Intravenous (outlier excluded a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. ) 1.2 ± 1.3 2.2 ± 3 0.26 Total (outlier excluded a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. ) 2.7 ± 5 2.8 ± 4 0.58 Catheter Exchanges No. catheter exchanges per patient per year of follow-up 0.3 1.1 Total no. patients requiring unplanned catheter exchanges (entire group) 6 (10) 21 (40) <0.01 Radiation Exposure Total REE (whole group) 71 407 Total number of patients with REE 17 (27) 51 (98) <0.01 Average REE per patient 1.1 c Represents average REE for all appendicostomy patients: average REE in appendicostomy patients with any event at all (17/63) was 4.1. 7.8 <0.01 Radiation exposure metrics b Radiation exposure metrics for REE with complete radiation data (50 events out of 71 events in the appendicostomy group and 136 events out of 407 events in the cecostomy group). Total number of REE 50 136 Mean DAP d DAP refers to ‘Dose Area Product’ and assesses radiation risk using the absorbed radiation dose and the area irradiated during the procedure. per event (mGy.cm2) 1003 488 <0.01 Median DAP per event (mGy.cm2) 396 185 <0.01 Mean reference air kerma e Air kerma is the sum of the initial kinetic energies of all the charged particles liberated by uncharged ionizing radiation (i.e: indirectly ionizing radiation such as photons and neutrons) in a sample of matter. It represents the absorbed dose or gray (Gy). Unlike DAP it is not related to the area radiated, only the dose of radiation. per event (mGy) 5.0 3.0 0.0013 Median reference air kerma per event (mGy) 2.8 1.2 0.0013 a Outlier who had 95 days of antibiotics related to cecal detachment and cardiac lesion excluded. b Radiation exposure metrics for REE with complete radiation data (50 events out of 71 events in the appendicostomy group and 136 events out of 407 events in the cecostomy group). c Represents average REE for all appendicostomy patients: average REE in appendicostomy patients with any event at all (17/63) was 4.1. d DAP refers to ‘Dose Area Product’ and assesses radiation risk using the absorbed radiation dose and the area irradiated during the procedure. e Air kerma is the sum of the initial kinetic energies of all the charged particles liberated by uncharged ionizing radiation (i.e: indirectly ionizing radiation such as photons and neutrons) in a sample of matter. It represents the absorbed dose or gray (Gy). Unlike DAP it is not related to the area radiated, only the dose of radiation. Open table in a new tab" @default.
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• W3044936410 date "2020-10-01" @default.
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• W3044936410 title "In-hospital resource utilization, outcome analysis and radiation exposure in children undergoing appendicostomy vs cecostomy tube placement" @default.
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• W3044936410 doi "https://doi.org/10.1016/j.jpurol.2020.07.022" @default.
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