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Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry.

Publication ,  Journal Article
Routh, JC; Joseph, DB; Liu, T; Schechter, MS; Thibadeau, JK; Chad Wallis, M; Ward, EA; Wiener, JS
Published in: J Pediatr Rehabil Med
December 11, 2017

PURPOSE: Optimal management of neurogenic bowel in patients with spina bifida (SB) remains controversial. Surgical interventions may be utilized to treat constipation and provide fecal continence, but their use may vary among SB treatment centers. METHODS: We queried the National Spina Bifida Patient Registry (NSBPR) to identify patients who underwent surgical interventions for neurogenic bowel. We abstracted demographic characteristics, SB type, functional level, concurrent bladder surgery, mobility, and NSBPR clinics to determine whether any of these factors were associated with interventions for management of neurogenic bowel. Multivariable logistic regression with adjustment for selection bias was performed. RESULTS: We identified 5,528 patients with SB enrolled in the 2009-14 NSBPR. Of these, 1,088 (19.7%) underwent procedures for neurogenic bowel, including 957 (17.3%) ACE/cecostomy tube and 155 (2.8%) ileostomy/colostomy patients. Procedures were more likely in patients who were older, white, non-ambulatory, with higher-level lesion, with myelomeningocele lesion, with private health insurance (all p< 0.001), and female (p= 0.006). On multivariable analysis, NSBPR clinic, older age (both p< 0.001), race (p= 0.002), mobility status (p= 0.011), higher lesion level (p< 0.001), private insurance (p= 0.002) and female sex (p= 0.015) were associated with increased odds of surgery. CONCLUSIONS: There is significant variation in rates of procedures to manage neurogenic bowel among NSBPR clinics. In addition to SB-related factors such as mobility status and lesion type/level, non-SB-related factors such as patient age, sex, race and treating center are also associated with the likelihood of undergoing neurogenic bowel intervention.

Duke Scholars

Published In

J Pediatr Rehabil Med

DOI

EISSN

1875-8894

Publication Date

December 11, 2017

Volume

10

Issue

3-4

Start / End Page

303 / 312

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Spinal Dysraphism
  • Registries
  • Practice Patterns, Physicians'
  • Neurogenic Bowel
  • Middle Aged
  • Male
  • Logistic Models
  • Infant
 

Citation

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MLA
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Routh, J. C., Joseph, D. B., Liu, T., Schechter, M. S., Thibadeau, J. K., Chad Wallis, M., … Wiener, J. S. (2017). Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry. J Pediatr Rehabil Med, 10(3–4), 303–312. https://doi.org/10.3233/PRM-170460
Routh, Jonathan C., David B. Joseph, Tiebin Liu, Michael S. Schechter, Judy K. Thibadeau, M. Chad Wallis, Elisabeth A. Ward, and John S. Wiener. “Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry.J Pediatr Rehabil Med 10, no. 3–4 (December 11, 2017): 303–12. https://doi.org/10.3233/PRM-170460.
Routh JC, Joseph DB, Liu T, Schechter MS, Thibadeau JK, Chad Wallis M, et al. Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry. J Pediatr Rehabil Med. 2017 Dec 11;10(3–4):303–12.
Routh, Jonathan C., et al. “Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry.J Pediatr Rehabil Med, vol. 10, no. 3–4, Dec. 2017, pp. 303–12. Pubmed, doi:10.3233/PRM-170460.
Routh JC, Joseph DB, Liu T, Schechter MS, Thibadeau JK, Chad Wallis M, Ward EA, Wiener JS. Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry. J Pediatr Rehabil Med. 2017 Dec 11;10(3–4):303–312.

Published In

J Pediatr Rehabil Med

DOI

EISSN

1875-8894

Publication Date

December 11, 2017

Volume

10

Issue

3-4

Start / End Page

303 / 312

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Spinal Dysraphism
  • Registries
  • Practice Patterns, Physicians'
  • Neurogenic Bowel
  • Middle Aged
  • Male
  • Logistic Models
  • Infant