Nelson Caleb P, Bloom David A, Dunn Rodney L, Wei John T
Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Urology. 2005 Aug;66(2):411-5. doi: 10.1016/j.urology.2005.03.007.
To use a large nationwide database to investigate and describe practice patterns in the contemporary management of bladder exstrophy.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (1988 to 2000) was queried to identify infants with bladder exstrophy hospitalized during the first week after birth. Admission and disposition patterns, resource utilization and length of stay, surgical repair trends, and factors associated with in-hospital death were analyzed.
We identified 426 hospital admissions of newborns with exstrophy. Most patients (75%) were transferred in from, or out to, other facilities; this was a fundamental feature of early exstrophy care. Racial differences were evident, with Hispanics less likely to be transferred (19% versus 60%, P = 0.001). Among newborns who were not transferred, many (46%) were discharged without bladder surgery. Surgical repair was usually done in a hospital other than the birth hospital; the mean hospital charges for surgery were 75,742 dollars. Of the 5 patients who died after repair, all had undergone surgery at "low-volume" hospitals. The length of stay did not change significantly during the study period, helping to keep resource utilization high in this population.
The results of this study provide a "snapshot" of bladder exstrophy practice patterns during the newborn period between 1988 and 2000. Additional research should investigate whether newborns with exstrophy are receiving optimal care, including appropriate timing of surgery, equitable transfers to tertiary centers, and reconstruction at centers with adequate volume and experience.
利用一个大型全国性数据库来调查和描述当代膀胱外翻管理中的实践模式。
查询医疗成本和利用项目全国住院样本（1988年至2000年），以确定出生后第一周内住院的膀胱外翻婴儿。分析入院和出院模式、资源利用和住院时间、手术修复趋势以及与院内死亡相关的因素。
我们确定了426例膀胱外翻新生儿的住院病例。大多数患者（75%）是从其他机构转入或转出；这是早期膀胱外翻护理的一个基本特征。种族差异明显，西班牙裔患者被转运的可能性较小（19%对60%，P = 0.001）。在未被转运的新生儿中，许多（46%）在未进行膀胱手术的情况下出院。手术修复通常在出生医院以外的医院进行；手术的平均住院费用为75,742美元。在修复后死亡的5例患者中，所有患者均在“低容量”医院接受了手术。在研究期间，住院时间没有显著变化，这使得该人群的资源利用率一直保持较高水平。
本研究结果提供了1988年至2000年新生儿期膀胱外翻实践模式的“快照”。进一步的研究应调查膀胱外翻新生儿是否得到了最佳护理，包括手术的适当时间、公平地转至三级中心以及在具备足够手术量和经验的中心进行重建。
