Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction

Introduction: Surgical treatment is still necessary for intussusception management in a subgroup of patients, despite advances in enema reduction techniques. Early identification of these patients should improve outcomes. Methods: The medical records of patients treated for intussusception at our institution from 2006 to 2011 were reviewed. Univariate and multivariate analyses, including stepwise logistic regression, were performed. Results: Overall, 379 patients were treated for intussusception, and 101 (26%) patients required operative management, with 34 undergoing intestinal resection. The post-operative complication rate was 8%. On multivariate analysis, failure of initial reduction (OR 9.9, p=0.001 95% CI, 4.6-21.2), a lead point (OR 18.5, p=0.001 95% CI, 6.6-51.8) or free/interloop fluid (OR 3.3, p=0.001 95% CI, 1.6-6.7) or bowel wall thickening on ultrasound (OR 3.3, p=0.001 95% CI, 1.1-10.1), age <1 year at reduction (OR 2.7, p=0.004, 95% CI, 1.4-5.9), and abdominal symptoms >2 days (OR 2.9, p=0.003, 95% CI, 1.4-5.9) were significantly associated with a requirement for surgery. Similarly, a lead point (OR 14.5, p=0.005 95% CI, 2.3-90.9) or free/interloop fluid on ultrasound (OR 19.8, p=0.001 95% CI, 3.4-117) and fever (OR 7.2, p=0.023 95% CI, 1.1-46) were significantly associated with the need for intestinal resection. Conclusion: Abdominal symptoms >2 days, age <1 year, multiple ultrasound findings, and failure of initial enema reduction are significant predictors of operative treatment for intussusception. Patients with these findings should be considered for early surgical consultation or transfer to a hospital with pediatric surgical capabilities. (C) 2013 Elsevier Inc. All rights reserved.