1997 - 2012年美国新生儿体外膜肺氧合的使用模式

Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997-2012.

作者信息

Song Ashley Y, Chen Hsuan-Hsiu Annie, Chapman Rachel, Govindarajan Ameish, Upperman Jeffrey S, Burke Rita V, Stein James, Friedlich Philippe S, Lakshmanan Ashwini

机构信息

Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.

出版信息

J Pediatr Surg. 2017 Oct;52(10):1681-1687. doi: 10.1016/j.jpedsurg.2017.05.026. Epub 2017 Jun 1.

DOI:10.1016/j.jpedsurg.2017.05.026

PMID:28622971

Abstract

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) remains one of the most intensive therapies for newborns in the United States. However, there is limited information on resource utilization for neonates receiving ECMO.

METHODS

We conducted a retrospective data analysis of the Kids' Inpatient Database from 1997 to 2012. Bivariate and multivariate analysis was completed to identify predictors of LOS, hospital costs and mortality. Cardiac and non-cardiac diagnoses of neonates receiving ECMO were also included in the bivariate and multivariable analysis.

RESULTS

Of the 5151 ECMO cases, survival to discharge was 62%. 22% had a principal cardiac diagnosis. After adjusting for covariates, increased mortality was associated with treatment in the midwest compared to the northeast region (aOR=2.0, p<0.01) and decreased among neonates with a non-cardiac diagnosis (aOR=0.4, p<0.01). Living in midwest was associated with longer LOS by 13days and increased hospital costs by 63,000 dollars (p<0.01). When stratified by non-cardiac diagnoses, infants with a diagnosis of congenital diaphragmatic hernia was associated with increased mortality (2.3, p<0.01) and longer LOS (25, p<0.01) and increased costs (11,100, p<0.01).

CONCLUSION

Neonates who received ECMO in certain regions of the United States were associated with poorer survival outcomes as well as increased LOS and hospital costs.

TYPE OF STUDY

Retrospective study.

LEVEL OF EVIDENCE

Level III.

摘要

背景

在美国，体外膜肺氧合（ECMO）仍然是治疗新生儿的最强化治疗手段之一。然而，关于接受ECMO治疗的新生儿资源利用情况的信息有限。

方法

我们对1997年至2012年儿童住院数据库进行了回顾性数据分析。完成了双变量和多变量分析，以确定住院时间、医院成本和死亡率的预测因素。接受ECMO治疗的新生儿的心脏和非心脏诊断也纳入了双变量和多变量分析。

结果

在5151例ECMO病例中，出院存活率为62%。22%的病例主要诊断为心脏疾病。在对协变量进行调整后，与东北地区相比，中西部地区接受治疗的新生儿死亡率增加（调整后比值比[aOR]=2.0，p<0.01），而非心脏诊断的新生儿死亡率降低（aOR=0.4，p<0.01）。生活在中西部地区与住院时间延长13天以及医院成本增加63000美元相关（p<0.01）。按非心脏诊断分层时，诊断为先天性膈疝的婴儿死亡率增加（2.3，p<0.01）、住院时间延长（25天，p<0.01）且成本增加（11100美元，p<0.01）。