P2.P307: Surgical outcomes in children with Intellectual and Developmental Disabilities

Background: The prevalence of children in 2019-2021, living with an intellectual or developmental disability (IDD) in the United States is significant (8.1%). Limited data exists on surgical outcomes in the IDD population. We aimed to assess if pediatric patients with IDD experience differing incidence of post-surgical complications compared to those without IDD.

Methods: We used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric Participant Use Data Files from 2012 to 2022. We designed 2 study cohorts: one for children undergoing appendectomy and the other for those having common surgical procedures (cholecystectomy, thoracic procedures, colon resection for Hirschsprung’s disease, gastrostomy, and laparoscopic fundoplication) as their index procedure. Children aged 2-18 years were included. The IDD group included children with developmental delay/impaired cognitive status, while the non-IDD group included all others. Primary outcomes included a composite of all complications and a composite of infectious complications. A composite of all complications included skin infection, wound disruption, systemic sepsis, pneumonia, urinary tract infection, venous thromboembolism, acute renal failure, pulmonary embolism, cerebrovascular event with neurological deficit, or 30-day readmission. An infection composite included the infectious complications in the primary composite outcome. Secondary outcomes included 30-day mortality and length of hospital stay (LOS).

We used inverse probability of treatment weighting to control for confounding and applied log-binomial regression models to estimate the weighted 30-day risk ratio (RR), 95% confidence intervals (CIs) for the primary outcomes and mortality. We used general linear models to estimate the weighted mean differences in LOS between the IDD and non-IDD group.

Results: There were 165,996 children in the appendectomy cohort and 39,462 children in the common surgical procedures cohort, of whom 3,273 (1.97%) and 11,575 (29.3%) patients had IDD, respectively. The IDD group had a 30-day RR, 95% CIs, of composite complications of 1.59 [1.36, 1.87] for appendectomy and 1.11 [1.03, 1.20] for common procedures. For composite post-operative infections, the IDD group had a 30-day RR, 95% CIs, of 1.44 [0.98, 2.12] for appendectomy and 1.65 [1.43, 1.91] for common procedures. Patients with IDD had longer LOS, with a mean difference, 95% CI, of 1.76 days [1.50, 2.02] for common procedures and 0.82 days [0.69, 0.95] for appendectomy. There was an overall higher 30-day RR of mortality in both cohorts (Table 1).

Conclusion: Children with IDD undergoing appendectomy and common surgical procedures experience worse 30-day post-operative outcomes, including several complications, infections, longer LOS, and higher mortality compared to those without IDD. Future research should investigate the root causes of these disparities and develop diverse strategies involving skilled multidisciplinary professionals to improve postoperative outcomes for children with IDD.