Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials & Outcomes Research, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Harvey 319, Baltimore, MD 21287-0005,
World J Surg. 2009 Dec;33(12):2714-21. doi: 10.1007/s00268-009-0219-8.
Mortality rates for eight surgical procedures have been endorsed by the Agency for Healthcare Research and Quality as part of the Inpatient Quality Indicators developed to assist hospitals in identifying potential problem areas and as an indirect measure of quality for inpatient adult surgical care. Little to no broad information relating to the overall mortality relating to the surgical care of children is available. An analysis providing national data on the most common procedures performed in children and their associated mortality would be useful in beginning to create benchmarks for standards of surgical care in the pediatric patient.
A total of 93 million admissions from the National Inpatient Sample (NIS) file from the years 1988-1996, 1998, 1999, 2001, 2002, 2004-2005 and the Kids Inpatient Database (KID) from 1997, 2000, 2003 were screened to identify surgical admissions in children under the age of 18 years. Variables such as gender, race, age at admission, length of hospital stay, total hospital charges, insurance status, and inpatient mortality were analyzed. Diagnosis related group (DRG) codes were used to provide inpatient mortality rates for 147 different procedures and 15 surgical subspecialties.
Over the 18-year period considered, a total of 2,087,915 surgical admissions in U.S. children were identified. Most of the patients were white (60.92%), male (54.64%), and were treated in urban, teaching hospitals (60.36%). Overall inpatient mortality was 0.85%, with a median hospital stay of 3 days. Procedures with the highest mortality were craniotomies for trauma (26.27%), liver and/or intestinal transplants (11.12%), heart transplants (10.94%), and other procedures for multiple significant trauma (10.69%). When analyzed by surgical subspecialty, gastrointestinal or general pediatric surgery saw the highest volume of patients, followed by orthopedic and ear, nose, and throat surgery (534,053 vs. 352,228 vs. 257,118 total procedures, respectively).
Pediatric surgical literature has classically focused on disease-based outcomes. However, such data do not provide a comprehensive profile of pediatric surgical outcomes by procedure or subspecialty. The present study provides nationwide data relating to inpatient pediatric surgical outcomes in U.S. hospitals by procedure and pediatric subspecialty.
医疗机构质量评估机构认可了八项外科手术的死亡率，这些手术作为住院质量指标的一部分，旨在帮助医院确定潜在的问题领域，并作为成人住院外科护理质量的间接衡量标准。关于儿童外科护理的整体死亡率，几乎没有广泛的信息。分析提供了在儿童中进行的最常见手术及其相关死亡率的全国数据，这将有助于为儿科患者的外科护理标准创建基准。
从 1988 年至 1996 年、1998 年、1999 年、2001 年、2002 年、2004 年至 2005 年的国家住院患者样本（NIS）文件以及 1997 年、2000 年、2003 年的儿童住院患者数据库（KID）中筛选出年龄在 18 岁以下的儿童外科住院患者。分析了性别、种族、入院年龄、住院时间、总住院费用、保险状况和住院死亡率等变量。使用诊断相关组（DRG）代码为 147 种不同的手术和 15 种外科亚专业提供住院死亡率。
在所考虑的 18 年期间，美国共有 2087915 例儿童外科手术。大多数患者为白人（60.92%），男性（54.64%），在城市、教学医院接受治疗（60.36%）。整体住院死亡率为 0.85%，中位住院时间为 3 天。死亡率最高的手术是创伤性开颅术（26.27%）、肝和/或肠移植术（11.12%）、心脏移植术（10.94%）和其他多发性严重创伤手术（10.69%）。按外科亚专业分析，胃肠病或普通儿科手术的患者量最大，其次是矫形和耳鼻喉手术（分别为 534053 例、352228 例和 257118 例）。
儿科外科文献传统上侧重于基于疾病的结果。然而，此类数据并不能全面描述儿科外科手术的结果。本研究提供了美国医院按手术和儿科亚专业划分的住院儿科手术结果的全国性数据。
