Hopper Richard A, Lewis Charlotte, Umbdenstock Renee, Garrison Michelle M, Starr Jacqueline R
Seattle, Wash. From the Seattle Children's Hospital Craniofacial Center, Department of Surgery, Department of Pediatrics, and Department of Epidemiology, and the School of Medicine, University of Washington; and Seattle Children's Hospital Research Institute.
Plast Reconstr Surg. 2009 May;123(5):1553-1559. doi: 10.1097/PRS.0b013e3181a0746e.
Discharge timing following primary cleft lip repair balances the desire to return patients to their home environment with the risk of serious complications occurring outside a hospital. To derive information to help estimate these risks, the authors evaluated discharge practices, readmissions, and serious medical complications following primary cleft lip repair at 23 children's hospitals in the Pediatric Health Information System over a 5-year period.
The primary outcomes were discharge the same day as surgery, readmission within 48 hours, and a serious medical complication occurring during the postoperative admission. Linear mixed models were fit to assess the independent association of the covariates with each outcome variable while accounting for the correlated nature of the data within each hospital.
Among 2558 patients undergoing primary cleft lip repair, 27.9 percent underwent same-day discharge, and 1.9 percent had an unscheduled readmission; 1.4 percent of the admitted patients had serious medical complications within 48 hours of their operation. Same-day discharge was associated with older age of the patient, absence of comorbidity, not having Medicaid, and having the surgery in a hospital with a higher annual volume of primary cleft lip repairs. Readmission was associated with Medicaid insurance and having had a surgeon with a higher primary cleft lip repair volume. Serious medical inpatient complications were associated with a preexisting patient comorbidity and a lower surgeon cleft volume.
A number of factors related to the hospital, surgeon, patient, and patient's family bear consideration in deciding the timing of discharge after primary cleft lip repair. The most clinically important factor appears to be the overall preexisting medical status of the patient.
一期唇裂修复术后的出院时机，需要在让患者回归家庭环境的愿望与医院外发生严重并发症的风险之间取得平衡。为获取有助于评估这些风险的信息，作者对儿科健康信息系统中23家儿童医院5年内一期唇裂修复术后的出院情况、再入院情况及严重医疗并发症进行了评估。
主要结局指标为手术当天出院、48小时内再入院以及术后住院期间发生严重医疗并发症。采用线性混合模型评估协变量与各结局变量之间的独立关联，同时考虑每家医院数据的相关性。
在2558例行一期唇裂修复术的患者中，27.9%的患者在手术当天出院，1.9%的患者意外再入院；1.4%的入院患者在术后48小时内发生严重医疗并发症。手术当天出院与患者年龄较大、无合并症、未参加医疗补助计划以及在每年一期唇裂修复手术量较高的医院接受手术有关。再入院与医疗补助保险以及主刀医生的一期唇裂修复手术量较高有关。严重医疗住院并发症与患者既往合并症以及医生的唇裂手术量较低有关。
在决定一期唇裂修复术后的出院时机时，需要考虑一些与医院、医生、患者及其家庭相关的因素。临床上最重要的因素似乎是患者既往的整体健康状况。
