Sayari Arash J, Tashiro Jun, Wang Bo, Perez Eduardo A, Lasko David S, Sola Juan E
Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
South Florida Pediatric Surgeons, P.A., Plantation, FL.
J Pediatr Surg. 2016 May;51(5):739-42. doi: 10.1016/j.jpedsurg.2016.02.014. Epub 2016 Feb 11.
We hypothesize that weekend esophageal atresia and tracheoesophageal fistula (EA/TEF) repair has worse outcomes compared to procedures performed on weekdays.
Kids' Inpatient Database (1997-2009) was searched for EA/TEF in infants admitted at <8days of life. Cases were limited to patients who underwent repair during their hospitalization. Risk-adjusted multivariate analysis (MVA) compared complications, mortality, and resource utilization (length of stay [LOS] total charges [TC]) between weekday and weekend procedures.
Overall, 861 EA/TEF cases with known day of repair were identified. Cohort survival was 96%. On risk-adjusted MVA, complication rates were higher with EA/TEF repair on a weekend (OR: 2.2) compared to a weekday. Additionally, complications (OR: 6.5) and LOS (OR: 9.3) were found to be higher among African American children compared to Caucasians. LOS was higher in patients with Medicaid (OR: 2.4) and repairs performed at non-teaching hospitals (OR: 3.2). Weekend vs. weekday procedure had no significant effect on mortality or resource utilization.
By risk-adjusted MVA, increased complication rates for EA/TEF are seen in patients undergoing repair on weekends compared to weekdays. Additionally, African American children experienced higher complication rates compared to Caucasians. LOS after repair varies according to race, payer status, and hospital characteristics.
我们假设与工作日进行的食管闭锁和气管食管瘘（EA/TEF）修复手术相比，周末进行该手术的预后更差。
在儿童住院数据库（1997 - 2009年）中搜索出生8天内入院的婴儿的EA/TEF病例。病例仅限于住院期间接受修复手术的患者。风险调整多变量分析（MVA）比较了工作日和周末手术之间的并发症、死亡率和资源利用情况（住院时间[LOS]、总费用[TC]）。
总体而言，共识别出861例已知修复日期的EA/TEF病例。队列生存率为96%。在风险调整的MVA中，与工作日相比，周末进行EA/TEF修复手术的并发症发生率更高（比值比：2.2）。此外，与白种人相比，非裔美国儿童的并发症（比值比：6.5）和住院时间（比值比：9.3）更高。医疗补助患者（比值比：2.4）和在非教学医院进行的修复手术（比值比：3.2）的住院时间更长。周末与工作日手术对死亡率或资源利用没有显著影响。
通过风险调整的MVA发现，与工作日进行修复手术的患者相比，周末进行EA/TEF修复手术的患者并发症发生率更高。此外，与白种人相比，非裔美国儿童的并发症发生率更高。修复后的住院时间因种族、付款人身份和医院特征而异。
