Camp Melissa, Chang David C, Zhang Yiyi, Chrouser Kristin, Colombani Paul M, Abdullah Fizan
Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA.
Arch Surg. 2010 Nov;145(11):1085-90. doi: 10.1001/archsurg.2010.241.
To determine risk factors and outcomes associated with a foreign body left during a procedure in a population of pediatric surgical patients.
Case-control study.
The Nationwide Inpatient Sample and Kids' Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (aged 0-18 years) from 1988 to 2005.
After data from 1 946 831 hospitalizations in children were linked to the Agency for Healthcare Research and Quality Pediatric Quality Indicator (PDI) software, 413 pediatric patients with foreign bodies left during a procedure (PDI 3) were identified. A 1:3 matched case-control design was implemented with 413 cases and 1227 controls. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes.
To examine the relationship between PDI 3 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges.
Logistic regression analysis revealed a statistically significant higher odds of PDI 3 in the gynecology procedure category (odds ratio, 4.13; P = .01). Multivariable regression analysis revealed that patients with PDI 3 had an 8-day longer length of stay (95% confidence interval, 5.6-10.3 days; P < .001) and $35 681 higher total hospital charges (95% confidence interval, $22 358-$49 004; P < .001) but were not more likely to die (odds ratio, 1.07; P = .92).
Among pediatric surgical admissions, a foreign body left during a procedure was observed to occur with highest likelihood during gynecologic operations. The occurrence of this adverse event was associated with longer length of stay and greater total hospital charges, but not with increased mortality.
确定小儿外科手术患者手术过程中遗留异物的相关危险因素及结局。
病例对照研究。
利用全国住院患者样本和儿童住院数据库，识别1988年至2005年在美国住院的小儿外科患者（年龄0至18岁）。
在将1946831例儿童住院数据与医疗保健研究与质量局的儿科质量指标（PDI）软件关联后，识别出413例手术过程中遗留异物的儿科患者（PDI 3）。采用1:3匹配病例对照设计，413例病例和1227例对照。根据诊断相关组手术编码，将病例和对照分为手术类别。
研究PDI 3与手术类别之间的关系，以及住院死亡率、住院时间和总住院费用等结局。
逻辑回归分析显示，妇科手术类别中PDI 3的几率在统计学上显著更高（优势比，4.13；P = 0.01）。多变量回归分析显示，PDI 3患者的住院时间长8天（95%置信区间，5.6 - 10.3天；P < 0.001），总住院费用高35681美元（95%置信区间，22358 - 49004美元；P < 0.001），但死亡可能性并不更高（优势比，1.07；P = 0.92）。
在小儿外科住院患者中，观察到手术过程中遗留异物在妇科手术中发生的可能性最高。这一不良事件的发生与住院时间延长和总住院费用增加有关，但与死亡率增加无关。
