Variations in pediatric intussusception management and outcomes across Aotearoa New Zealand: A national multicenter retrospective study

Introduction: Intussusception is a relatively common pediatric surgical pathology, but no standardized management guideline exists in Aotearoa New Zealand (AoNZ). We therefore aimed to conduct a national audit of intussusception management across AoNZ and describe any practice variations. Methods: We performed a national 15-year retrospective, multicenter cohort study of all children treated for intussusception between 01 Jan 2007 and 01 Jan 2022 across AoNZ. We analyzed clinical and radiological data to determine inter-center variation, including treatment intent, subsequent management, and success rates. Results: Six hospitals managed 529 children with intussusception. The median age at presentation was ten months (1m - 14.9y). Primary enema reduction was attempted in 88.5 % of cases, varying from 80 - 100 %. After post hoc exclusion of cases requiring resection, there was significant variation in enema reduction success (58.8 % - 100 %; p < 0.001). The overall general anesthesia rate was 36 % (8 - 46 %), mostly from secondary operative management after failed enema reduction (8 - 38 %). Delay to enema reduction >48 h was associated with a lower success rate (60.5 % vs 79.7 %; p < 0.001) and with all four perforations (0.9 %). Enema success was more dependent on the prehospital duration of symptoms (25.8 h vs. 46.8 h; p < 0.001) and prehospital transfer (68.7 % vs. 78.4 %; p = 0.012) than in-hospital delay to reduction (3.4 h vs. 3.6 h; p = 0.79). Conclusions: We demonstrated a wide range of enema reduction success rates and subsequent operative management requirements across AoNZ. Prehospital delay in treatment was associated with the failure of enema reduction. Investigation into enema reduction practices and subsequent national care standardization is urgently recommended.