Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
Division of Biostatistics, Department of Child and Adolescent Psychiatry, New York University, New York, NY.
J Thorac Cardiovasc Surg. 2015 Jan;149(1):205-10.e1. doi: 10.1016/j.jtcvs.2014.07.094. Epub 2014 Aug 8.
Our aim was to examine the effects of surgical timing on major morbidity, mortality, and total hospital reimbursement for late preterm and term infants with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation within the first 2 weeks of life.
We conducted a retrospective cohort study of infants aged ≥35 weeks gestation, with HLHS, admitted to our institution at age ≤5 days, between January 1, 2003, and January 1, 2013. Children with other cardiac abnormalities or other major comorbid conditions were excluded. Univariable and multivariable analyses were performed to determine the association between age at stage 1 palliation and major morbidity, mortality, and hospital reimbursement.
One hundred thirty-four children met inclusion criteria. Mortality was 7.5% (n = 10). Forty-three percent (n = 58) experienced major morbidity. Median costs were $97,000, in 2013 dollars (interquartile range, $72,000-$151,000). Median age at operation was 5 days (interquartile range, 3-7 days; full range, 1-14 days). All deaths occurred in patients operated on between 4 and 8 days of life. For every day later that surgery was performed, the odds of major morbidity rose by 15.7% (95% confidence interval, 2.5%-30.7%; P = .018) and costs rose by 4.7% (95% confidence interval, 0.9%-8.2%; P < .014).
Delay of stage 1 palliation for neonates with HLHS is associated with increased morbidity and health care costs, even within the first 2 weeks of life.
本研究旨在探讨在生命的前 2 周内接受一期姑息性手术的患有左心发育不良综合征（HLHS）的晚期早产儿和足月儿中，手术时机对主要发病率、死亡率和总医院报销的影响。
我们对 2003 年 1 月 1 日至 2013 年 1 月 1 日期间在我院入院年龄≤5 天、胎龄≥35 周的 HLHS 患儿进行了回顾性队列研究。排除合并其他心脏异常或其他主要合并症的患儿。采用单变量和多变量分析来确定一期姑息性手术年龄与主要发病率、死亡率和医院报销之间的关系。
共纳入 134 名患儿。死亡率为 7.5%（n=10）。43%（n=58）出现主要并发症。2013 年的中位费用为 97000 美元（四分位距，72000-151000 美元）。手术中位年龄为 5 天（四分位距，3-7 天；全范围，1-14 天）。所有死亡均发生在 4-8 天内接受手术的患者中。手术每推迟一天，主要并发症的发生几率增加 15.7%（95%置信区间，2.5%-30.7%；P=0.018），费用增加 4.7%（95%置信区间，0.9%-8.2%；P<0.014）。
即使在生命的前 2 周内，对患有 HLHS 的新生儿延迟进行一期姑息性手术与发病率和医疗保健费用的增加有关。
