美国尿道成形术的趋势、应用情况及围手术期即刻并发症：来自2000 - 2010年全国住院患者样本的数据
Trends, utilization, and immediate perioperative complications of urethroplasty in the United States: data from the national inpatient sample 2000-2010.
作者信息
Blaschko Sarah D, Harris Catherine R, Zaid Uwais B, Gaither Tom, Chu Carissa, Alwaal Amjad, McAninch Jack W, McCulloch Charles E, Breyer Benjamin N
机构信息
Department of Urology, University of California, San Francisco, San Francisco, CA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
出版信息
Urology. 2015 May;85(5):1190-1194. doi: 10.1016/j.urology.2015.01.008. Epub 2015 Mar 4.
OBJECTIVE
To determine national urethroplasty trends based on type of surgery and patient and hospital characteristics. We hypothesized that the number of complex urethroplasty procedures performed has increased over time and may be associated with increased periprocedure complications.
METHODS
The National Inpatient Sample from years 2000 to 2010 was queried for patients with urethroplasty-associated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We analyzed trends in urethroplasty procedures, patient demographics, comorbidities, and hospital characteristics. We evaluated the relationship between patient demographics and comorbid disease, length of hospital stay, hospital charges, and inpatient complications.
RESULTS
During the study period, an estimated 13,700 men (95% confidence interval, 9507-17,894) underwent urethroplasty nationally. Excision with primary anastomosis, buccal graft, and other graft or flap urethroplasty comprised 80.3%, 14.3%, and 5.4%, respectively. Buccal mucosa graft procedures increased over time (P = .03). Only 1.6% of hospitals have ≥ 20 urethroplasties performed annually. Urethroplasty type and urethroplasty volume were not associated with immediate complication rates. Hypertension, diabetes, chronic pulmonary disease, and obesity were the most common comorbidities in urethroplasty patients. Complications during urethroplasty hospitalization occurred in 6.6% of men, with surgical or wound complications being the most common (5.2%). Postoperative mortality was exceedingly rare. Older patients, African Americans, and patients with increased comorbidities were more likely to have complications.
CONCLUSION
An increasing number of buccal mucosa graft urethroplasties occurred over time. Urethroplasty patients have low immediate perioperative morbidity (6.6%) and mortality (0.07%). Patients who are older, African American, or have more comorbid conditions have greater risk for complications.
目的
根据手术类型、患者及医院特征确定全国尿道成形术的趋势。我们假设随着时间推移，复杂尿道成形术的实施数量有所增加，且可能与围手术期并发症增多相关。
方法
查询2000年至2010年的全国住院患者样本，找出患有与尿道成形术相关的国际疾病分类第九版临床修订本编码的患者。我们分析了尿道成形术的手术趋势、患者人口统计学特征、合并症及医院特征。我们评估了患者人口统计学特征与合并疾病、住院时间、住院费用及住院并发症之间的关系。
结果
在研究期间，全国估计有13700名男性（95%置信区间为9507 - 17894）接受了尿道成形术。一期吻合切除、颊黏膜移植及其他移植或皮瓣尿道成形术分别占80.3%、14.3%和5.4%。颊黏膜移植手术随时间增加（P = 0.03）。每年进行≥20例尿道成形术的医院仅占1.6%。尿道成形术类型及尿道成形术例数与即刻并发症发生率无关。高血压、糖尿病、慢性肺病及肥胖是尿道成形术患者最常见的合并症。尿道成形术住院期间并发症发生在6.6%的男性患者中，手术或伤口并发症最为常见（5.2%）。术后死亡率极低。老年患者、非裔美国人及合并症增多的患者更易发生并发症。
结论
随着时间推移，颊黏膜移植尿道成形术的数量不断增加。尿道成形术患者围手术期即刻发病率较低（6.6%），死亡率较低（0.07%）。年龄较大、非裔美国人或合并症较多的患者发生并发症的风险更高。
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