1Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, Grand Rapids, MI. 2Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI. 3Department of Pediatric Surgery, Helen DeVos Children's Hospital, Grand Rapids, MI.
Pediatr Crit Care Med. 2014 Jan;15(1):71-6. doi: 10.1097/PCC.0000000000000022.
To compare the cost and safety of placement of Broviac catheters in children by pediatric intensivists in a sedation suite versus placement by pediatric surgeons in the operating room.
Single-center retrospective analysis.
Pediatric sedation suite and operating rooms in a tertiary care children's hospital.
All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009.
None.
We reviewed the charts of all pediatric patients with Broviac catheters placed, either by intensivists or surgeons, and compared cost and outcomes. Procedure safety was assessed and categorized into immediate, short-term (within 2 wk of procedure), and long-term outcomes. Anesthetic safety and billing data for the procedure were also collected. Among similar patient populations, immediate complications, such as pneumothorax, procedure failure (p > 0.999), and anesthetic complications (p = 0.60), were not significantly different. Short-term outcomes, including infection (p = 0.27) and catheter malfunction (p > 0.999), were not different. Long-term outcomes, including mean indwelling catheter days (p = 0.60) and removal due to catheter infection (p = 0.09), were not different between the groups. Overall cost of the procedure was significantly different: $7,031 (± $784) when performed by surgeons and $3,565 (± $311) when performed by intensivists (p < 0.001).
Pediatric critical care physicians can place Broviac catheters as safely as pediatric surgeons and at a lower cost in a defined patient population.
比较在镇静套房中由儿科重症监护医生和在手术室中由小儿外科医生置管的布罗维亚导管在儿童中的成本和安全性。
单中心回顾性分析。
三级儿童医院的儿科镇静套房和手术室。
2007 年至 2009 年期间在该机构接受布罗维亚导管置管的所有儿科患者（n=253）。
无。
我们回顾了所有接受布罗维亚导管置管的儿科患者的病历，这些患者是由重症监护医生还是外科医生进行置管的，并比较了成本和结果。评估了程序安全性，并将其分类为即时、短期（程序后 2 周内）和长期结果。还收集了麻醉安全性和程序计费数据。在类似的患者人群中，即时并发症，如气胸、程序失败（p>0.999）和麻醉并发症（p=0.60）没有显著差异。短期结果，包括感染（p=0.27）和导管故障（p>0.999），两组之间无差异。长期结果，包括平均留置导管天数（p=0.60）和因导管感染而拔除（p=0.09），两组之间无差异。该手术的总费用有显著差异：外科医生操作的费用为 7031 美元（±784 美元），而重症监护医生操作的费用为 3565 美元（±311 美元）（p<0.001）。
在特定患者人群中，儿科重症监护医生可以像小儿外科医生一样安全地置管布罗维亚导管，且成本更低。
