Department of Surgery and Pediatrics, The University of Tennessee Health Science Center, Memphis, TN 38105, USA.
Ann Surg. 2013 Feb;257(2):371-5. doi: 10.1097/SLA.0b013e31827ee976.
This study investigates how the epidemiology, hospital utilization, and surgical management of Hirschsprung disease (HD) have changed over the last decade in the United States, using a statistically valid national sample.
HD is a congenital gastrointestinal disorder that requires surgical resection for correction. Some patients experience long-term bowel dysfunction requiring hospital care. Historically, patients had multiple staged operations, whereas more recently, single-stage laparoscopic resection and pull-through operations are more common. Assessment of possible changes over time in HD-associated complications requiring hospitalization and length of hospital stay has not been quantified epidemiologically.
The Kids' Inpatient Database was queried for all discharges with an International Classification of Disease, Ninth Revision, Clinical Modification code for HD in the years 1997, 2000, 2003, and 2006. The HD cohorts from these 4 time points were compared, specifically analyzing differences in demographic data, associated diagnoses, in-hospital mortality and length of stay, procedures performed during hospitalization, and frequency of hospitalizations for HD-associated complications. Results reported included estimated frequencies and means with 95% confidence intervals.
The estimated numbers of HD discharges, associated demographic data, and numbers of pull-through procedures have remained stable over the decade. The mean age (years) at the time of pull-through has decreased from 1.45 to 1.16 to 1.18 to 0.97 (P = 0.01). The mean length of stay (days) for these procedures has increased from 8.40 to 8.46 to 9.25 to 10.55 (P = 0.002). The estimated numbers of hospital admissions for HD-related constipation increased in recent years from 395 to 340 to 536 to 566 (P = 0.001). The estimated numbers of admissions for enterocolitis suggest an increasing trend from 466 to 402 to 584 to 556 (P = 0.11).
HD pull-through procedures are being performed at younger ages over time, and post-pull-through lengths of stay have increased. Admissions for some HD-related complications have increased over the decade. Prospective cohort studies are needed to determine whether causal relationships exist among these trends.
本研究使用具有统计学意义的全国样本，调查美国过去十年中先天性巨结肠症（HD）的流行病学、医院利用情况和手术管理方式的变化。
HD 是一种先天性胃肠道疾病，需要手术切除进行矫正。一些患者会长期出现肠道功能障碍，需要住院治疗。历史上，患者需要进行多次分期手术，而最近，腹腔镜一期切除和拖出手术更为常见。评估 HD 相关并发症导致住院和住院时间变化的可能性尚未从流行病学角度进行量化。
在 1997 年、2000 年、2003 年和 2006 年，通过国际疾病分类，第九版临床修订版（ICD-9-CM）代码，对所有患有 HD 的住院患者进行了 Kids' Inpatient Database 检索。对这 4 个时间点的 HD 队列进行了比较，具体分析了人口统计学数据、相关诊断、院内死亡率和住院时间、住院期间进行的手术以及因 HD 相关并发症住院的频率差异。报告的结果包括估计频率和 95%置信区间的平均值。
在过去的十年中，HD 出院人数、相关人口统计学数据和拖出手术数量保持稳定。拖出术时的平均年龄（岁）从 1.45 岁降至 1.16 岁、1.18 岁和 0.97 岁（P=0.01）。这些手术的平均住院时间（天）从 8.40 天增加到 8.46 天、9.25 天和 10.55 天（P=0.002）。近年来，因 HD 相关便秘而住院的人数从 395 人增加到 340 人、536 人、566 人（P=0.001）。因结肠炎而住院的人数从 466 人增加到 402 人、584 人、556 人（P=0.11），提示呈上升趋势。
随着时间的推移，HD 拖出术的年龄越来越小，拖出术后的住院时间延长。过去十年中，一些与 HD 相关的并发症的住院人数有所增加。需要前瞻性队列研究来确定这些趋势之间是否存在因果关系。
