Children's Hospital Boston, Department of Urology, 300 Longwood Ave, HU-355, Boston, MA 02115.
Pediatrics. 2010 Mar;125(3):e446-51. doi: 10.1542/peds.2009-1237. Epub 2010 Feb 8.
Controversy exists over surgical procedure choice for vesicoureteral reflux (VUR) in children. Either ureteral reimplantation (UR) or a newer procedure, endoscopic injection (EI), may be chosen; however, the factors that determine procedure choice for any individual patient are unclear. The objective of this study was to identify patient and hospital factors associated with the choice of EI for children undergoing antireflux surgery.
We searched the Pediatric Health Information System, a national database collected by freestanding children's hospitals. We identified children aged <18 years with primary VUR who underwent surgery (UR or EI) between 2003 and 2008. We used multivariate logistic regression models to evaluate whether the type of procedure performed was associated with hospital-level factors including individual hospital, hospital region, size, and teaching status, as well as patient features including age, race, gender, and insurance type.
We identified 15026 children with primary VUR who underwent antireflux surgery between 2003 and 2008. Of these, 3611 children (24%) were treated at hospitals that performed reimplant only. Among children treated at institutions offering both procedures, 5562 (49%) underwent injection and 5853 (51%) underwent reimplant. Patients who received EI were significantly older and more likely to be girls, white, and publicly insured than those who had UR. They were more likely to have been treated at hospitals that were larger, were teaching hospitals, or were located in larger metropolitan areas or the South rather than the Northeast. After adjusting for other covariates, the treating hospital was the most important factor predicting procedure choice.
The hospital at which a patient receives treatment is the single most important feature that drove procedure choice for children with primary VUR. The patient's age, gender, insurance status, and disease severity played a smaller, although significant, role.
儿童膀胱输尿管反流（VUR）的手术方式选择存在争议。可以选择输尿管再植术（UR）或较新的内镜注射（EI）；然而，对于任何个体患者，决定手术方式的因素尚不清楚。本研究的目的是确定与接受抗反流手术的儿童选择 EI 相关的患者和医院因素。
我们搜索了儿科健康信息系统，这是一个由独立儿童医院收集的全国性数据库。我们确定了 2003 年至 2008 年间接受手术（UR 或 EI）的年龄<18 岁的原发性 VUR 儿童。我们使用多变量逻辑回归模型评估所进行的手术类型是否与医院级别因素相关，包括单个医院、医院所在地区、规模和教学状态，以及患者特征，包括年龄、种族、性别和保险类型。
我们确定了 2003 年至 2008 年间接受原发性 VUR 抗反流手术的 15026 名儿童。其中，3611 名（24%）在仅进行再植术的医院接受治疗。在接受两种手术的机构治疗的儿童中，5562 名（49%）接受了注射治疗，5853 名（51%）接受了再植治疗。接受 EI 治疗的患者年龄明显较大，更可能是女性、白人且有公共保险，而接受 UR 治疗的患者则不是。他们更可能在规模较大、是教学医院、位于较大的大都市区或南部而不是东北部的医院接受治疗。在调整了其他协变量后，治疗医院是预测手术方式选择的最重要因素。
患者接受治疗的医院是决定原发性 VUR 儿童手术方式选择的最重要特征。患者的年龄、性别、保险状况和疾病严重程度虽然作用较小，但也具有重要意义。
