Poenaru Dan, Pemberton Julia, Cameron Brian H
McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4K1; BethanyKids at Myung Sung Christian Medical Center, Addis Ababa, Ethiopia.
McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4K1; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1.
J Pediatr Surg. 2015 May;50(5):765-70. doi: 10.1016/j.jpedsurg.2015.02.033. Epub 2015 Feb 20.
Disability-adjusted life years (DALYs) have become the standard metric for estimating burden of disease (BoD), but have not yet been applied to delayed access to surgical procedures. This study estimates the DALYs accrued from delayed access to surgical care in two pediatric surgical units in Kenya and Canada.
Records of operations for 13 congenital health states in a Kenyan and a Canadian hospital were prospectively collected for 2012. DALYs caused by delayed presentation were estimated using disability weights and ideal and actual age at surgery.
1208 first-time procedures in general surgery, neurosurgery, plastic surgery, and urology were included. Delays were longest in general surgery and longer in Kenya than in Canada in all specialties. The longest delays in Kenya were for orchidopexy (72 months) and anorectoplasty (PSARP) (74 months), and in Canada for orchidopexy (40 months). Corresponding total delayed BoD was highest in general surgery and neurosurgery and higher again in Kenya than in Canada (484 cf. 84 DALYs).
Estimating BoD resulting from delayed surgery is feasible and reflects both late presentation and limited access to care. Further exploration of these factors can make delayed DALYs a useful measure of health care coverage and waitlist prioritization.
伤残调整生命年（DALYs）已成为估计疾病负担（BoD）的标准指标，但尚未应用于手术延迟。本研究估计了肯尼亚和加拿大两个儿科手术科室因手术延迟而产生的伤残调整生命年。
前瞻性收集了2012年肯尼亚和加拿大一家医院13种先天性健康状况的手术记录。使用残疾权重以及手术时的理想年龄和实际年龄来估计延迟就诊导致的伤残调整生命年。
纳入了普通外科、神经外科、整形外科和泌尿外科的1208例首次手术。所有专科中，普通外科的延迟时间最长，肯尼亚的延迟时间比加拿大更长。肯尼亚延迟时间最长的是睾丸固定术（72个月）和肛门直肠成形术（经肛门直肠拖出术）（74个月），加拿大是睾丸固定术（40个月）。相应的总延迟疾病负担在普通外科和神经外科最高，肯尼亚再次高于加拿大（484对比84伤残调整生命年）。
估计手术延迟导致的疾病负担是可行的，并且反映了就诊延迟和获得医疗服务受限的情况。对这些因素的进一步探索可使延迟伤残调整生命年成为衡量医疗保健覆盖范围和等待名单优先排序的有用指标。
