Skarsgard Erik D
Department of Surgery, British Columbia Children's Hospital, University of British Columbia, and Centre for Healthcare Innovation and Improvement, Vancouver, British Columbia.
Paediatr Child Health. 2006 Jan;11(1):15-8.
There has been a recent trend of improved outcomes for most infants born with surgically correctable congenital malformations, despite the fact that current surgical treatment is not standardized, with wide variations in practice among institutions. Because care for these infants is multidisciplinary, it is difficult to ascertain with clarity the specific role of neonatal surgery in determining outcomes. Moreover, the lack of validated measures of illness severity for most complex congenital malformations makes risk adjustment difficult. For these reasons, the utility of randomized controlled trials in determining best surgical practice in neonatal surgery for congenital malformations is impractical, and another means of deriving medical evidence to justify 'optimal' treatment is necessary.The Canadian Paediatric Surgical Network (CAPSNet) was developed specifically to address these issues. Patterned after the highly successful Canadian Neonatal Network, CAPSNet collects standardized data on every case of gastroschisis and congenital diaphragmatic hernia evaluated in the 16 referral perinatal centres in Canada. These centres serve as provincial referral centres for perinatal care, and, therefore, the data set created is population-based for gastroschisis and congenital diaphragmatic hernia in Canada. In addition to neonatal data fields recorded in the Canadian Neonatal Network, CAPSNet collects specific prenatal data, and details on surgical treatment and outcomes within each of the 16 participating centres. It is hoped that by using advanced analytical techniques, including outcomes modelling and multiple logistic regression analysis of risk-adjusted outcome variations by type of surgery performed, optimal treatment paradigms will be identified that will lead to further outcome improvement in babies born with complex birth defects.
尽管目前的手术治疗尚未标准化，各机构的实际操作差异很大，但最近大多数患有可通过手术矫正的先天性畸形的婴儿的治疗结果有改善的趋势。由于对这些婴儿的护理是多学科的，很难明确确定新生儿手术在决定治疗结果中的具体作用。此外，对于大多数复杂的先天性畸形，缺乏经过验证的疾病严重程度衡量标准，这使得风险调整变得困难。由于这些原因，随机对照试验在确定先天性畸形新生儿手术的最佳手术方法方面并不实用，因此需要另一种获取医学证据来证明“最佳”治疗方法的手段。加拿大儿科手术网络（CAPSNet）就是专门为解决这些问题而设立的。CAPSNet仿照非常成功的加拿大新生儿网络建立，收集了加拿大16个围产期转诊中心评估的每一例腹裂和先天性膈疝病例的标准化数据。这些中心是省级围产期护理转诊中心，因此所创建的数据集是以加拿大腹裂和先天性膈疝的人群为基础的。除了加拿大新生儿网络记录的新生儿数据字段外，CAPSNet还收集特定的产前数据，以及16个参与中心各自的手术治疗和结果细节。希望通过使用先进的分析技术，包括结果建模和对按所实施手术类型进行风险调整后的结果差异进行多元逻辑回归分析，能够确定最佳治疗模式，从而进一步改善患有复杂出生缺陷婴儿的治疗结果。
