Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
J Pediatr Surg. 2011 Apr;46(4):648-654. doi: 10.1016/j.jpedsurg.2010.09.012.
BACKGROUND/PURPOSE: Increasing national focus on patient safety has promoted development of the pediatric quality indicators (PDIs), which screen for preventable events during provision of health care for children. Our objective is to apply these safety metrics to compare 2 surgical procedures in children, specifically laparoscopic and open esophagogastric fundoplication for gastroesophageal reflux.
A retrospective analysis using 20 years of data from national representative state inpatient databases through the Healthcare Cost and Utilization Project was conducted. Patients younger than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for open or laparoscopic esophagogastric fundoplication were included. Pediatric quality indicators were linked to each patient's profile. Demographics, comorbidities, outcomes, and 8 selected PDIs between open and laparoscopic fundoplications were compared using Pearson χ(2) tests and t tests.
Of 33,533 patients identified, 28,141 underwent open and 5392 underwent laparoscopic fundoplication. Comorbidities occurred more frequently in open surgery. In-hospital mortality, length of stay, and hospital charges were less in laparoscopic surgery. Of the 8 PDIs evaluated, decubitus ulcer (P = .04) and postoperative sepsis (P = .003) had decreased rates with laparoscopic surgery compared with open.
Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.
背景/目的：对患者安全的日益关注推动了儿科质量指标（PDI）的发展，这些指标可筛查儿童保健过程中可预防的事件。我们的目的是应用这些安全指标来比较两种儿童外科手术，即腹腔镜和开放式胃食管反流抗反流术。
采用回顾性分析，使用医疗保健成本和利用项目（Healthcare Cost and Utilization Project）全国代表性州住院患者数据库 20 年的数据。纳入国际疾病分类第 9 修订版临床修正版（International Classification of Diseases, Ninth Revision, Clinical Modification）编码为开放式或腹腔镜胃食管反流抗反流术的年龄小于 18 岁的患者。将儿科质量指标与每位患者的个人资料相关联。采用 Pearson χ(2)检验和 t 检验比较开放式和腹腔镜胃食管反流抗反流术之间的人口统计学、合并症、结局和 8 项选定的 PDI。
在确定的 33533 名患者中，28141 名接受了开放式手术，5392 名接受了腹腔镜手术。开放式手术中更常出现合并症。腹腔镜手术的住院死亡率、住院时间和住院费用较低。在评估的 8 项 PDI 中，与开放式手术相比，腹腔镜手术的褥疮（P =.04）和术后败血症（P =.003）发生率降低。
与开放式手术相比，腹腔镜胃食管反流抗反流术在儿童中可以安全进行，且具有同等或更高的 PDI 率。
