Washington, D.C. From the Departments of Plastic Surgery and Neurosurgery at Children's National Medical Center and the George Washington School of Medicine.
Plast Reconstr Surg. 2013 Apr;131(4):582e-588e. doi: 10.1097/PRS.0b013e3182818e94.
Intensive care unit admission following fronto-orbital advancement for craniosynostosis is routine at most institutions. The authors determined the frequency of postoperative events requiring intensive care unit care that justify this practice.
Infants with craniosynostosis who underwent primary fronto-orbital advancement at a single institution from 1997 to 2011 were included. Patient demographics, operative factors, and hemodynamic outcomes were recorded. Adverse postoperative events/interventions were graded as none (group I); minor (group II), easily managed on a surgical floor; or major (group III), requiring intensive care unit care.
One hundred seven infants were included. Average length of hospitalization was 3.7 ± 1.6 days, with 1.3 ± 1.0 days in the intensive care unit and 2.4 ± 1.0 days on the floor. Seventy-eight patients (72.9 percent) were categorized into group I, 24 (22.4 percent) into group II, and five (4.7 percent) into group III. Major events/interventions included prolonged intubation (n = 2), reintubation (n = 2), and continuous positive airway pressure support (n = 1). Preexisting end-organ dysfunction was significantly associated with group III patients, who also had significantly higher intraoperative blood loss requiring greater resuscitation. Mean daily charges were $7652.33 (10.9 percent of total charges) for intensive care unit care and $2470.62 (6.9 percent of total charges) for floor care.
In this study, 4.7 percent of patients had event/interventions requiring intensive care unit care after fronto-orbital advancement. Predictors included preexisting end-organ dysfunction and higher intraoperative blood loss requiring greater resuscitation. Financial savings from selective postoperative intensive care unit admission may not outweigh the potential cost of an emergent event on the surgical floor.
大多数机构在进行颅缝早闭的前额眶部推进术后，都会将患者收入重症监护病房。作者旨在确定术后需要重症监护病房护理的事件频率，以证明这种治疗方法的合理性。
本研究纳入了 1997 年至 2011 年期间在单家机构接受原发性前额眶部推进术的颅缝早闭患儿。记录患者的人口统计学资料、手术因素和血流动力学结果。将术后不良事件/干预措施分为无（I 组）；轻微（II 组），在外科病房即可轻松管理；或严重（III 组），需要重症监护病房护理。
共纳入 107 例患儿。平均住院时间为 3.7 ± 1.6 天，重症监护病房 1.3 ± 1.0 天，普通病房 2.4 ± 1.0 天。78 例（72.9%）患儿归入 I 组，24 例（22.4%）归入 II 组，5 例（4.7%）归入 III 组。严重事件/干预措施包括延长插管（n=2）、再次插管（n=2）和持续气道正压通气支持（n=1）。存在预先存在的终末器官功能障碍与 III 组患者显著相关，III 组患者的术中出血量也明显更高，需要更大的复苏。重症监护病房护理的日平均费用为 7652.33 美元（占总费用的 10.9%），普通病房护理的日平均费用为 2470.62 美元（占总费用的 6.9%）。
在这项研究中，4.7%的前额眶部推进术后患者需要接受重症监护病房护理的事件/干预。预测因素包括预先存在的终末器官功能障碍和需要更大复苏的术中大量出血。选择性术后入住重症监护病房可能不会带来经济效益，因为在外科病房发生紧急事件的潜在成本可能更高。
