Nationwide Population-Based Epidemiologic Study on Childhood Intussusception in South Korea: Emphasis on Treatment and Outcomes

Abstract

Purpose: This was a nationwide population-based study conducted to investigate the epidemiology, treatment, disease outcomes, and associated factors of childhood intussusception in South Korea.

Methods: Data from the Korean National Health Insurance Service database on all patients <18 years old diagnosed with intussusception from 2007 to 2017 were analyzed.

Results: A total of 34,688 cases were identified among 30,444 patients. The overall incidence was 28.3/100,000 person-years with a male predominance. Most cases (83.1%) occurred in children <3 years old, with an annual incidence of 195.2, 200.1, and 118.6 cases per 100,000 children in their first, second, and third year of life, respectively. The median age at the first occurrence was 18.7 months, and it was higher in boys than in girls. The post-discharge recurrence rate was 10.6% (3,226/30,444) and the in-hospital recurrence rate was 6.1% (1,842/30,444). The total recurrence rate (post-discharge recurrence and/or in-hospital recurrence) was 15.0% (4,580/30,444). Enema reduction was successful in 90.0% of cases. Enema reduction was more successful in girls than in boys. A total of 3,296 (10.8%) patients underwent 3,481 surgeries, including 735 (21.1%) laparoscopic surgeries. Post-discharge recurrence and surgery were significantly affected by age, sex, and hospital type. Mortality was noted in nine cases (0.03%).

Conclusion: Our study provides accurate epidemiologic data on the treatment and outcomes of intussusception through complete enumeration during an 11-year-period.

Keywords: Child; Epidemiology; Intussusception; Outcome; Treatment.

Fig. 1. Annual incidence of intussusception in patients <18 years old between 2007 and 2017 in South Korea. (A) Annual new cases of intussusception and annual mid-year population. (B) The annual incidence, except in 2010, generally decreased from 30.2/10⁵ person-years in 2007 to 23.9/10⁵ person-years in 2017 based on the incidence in 2007 as the mid-year population continuously decreased from 109 million in 2007 to 86 million in 2017. The incidence in 2013 and 2016 were not statistically significantly different. ^*The incidence in 2010 was significantly higher than that in 2007. The overall intussusception incidence was 28.3/10⁵ person-years.

Fig. 2. Age- and sex- specific incidence of intussusception in patients <18 years of age between 2007 and 2017 in South Korea. (A) Age- and sex- specific incidence at every 1 year in patients younger than 18 years. The incidence is presented per 10⁵ person-years. (B) Cumulative percentage of age- and sex-specific incidence.

Fig. 3. Annual numbers of surgeries in children with intussusception between 2007 and 2017 in South Korea. As annual new cases of intussusception decreased, the annual surgery numbers and laparotomy numbers also decreased. However, the laparoscopic surgery numbers continuously increased.