Baker Andrew B, Farhood Zachary, Brandstetter Kathleen A, Teufel Ronald J, LaRosa Angela, White David R
1 Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
2 Department of Otolaryngology-Head and Neck Surgery, St Louis University, St Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2017 Sep;157(3):499-503. doi: 10.1177/0194599817711377. Epub 2017 Aug 1.
Objective To describe the cost, length of stay, and incidence of postoperative hemorrhage associated with Down syndrome (DS) patients undergoing tonsillectomy in a national sample of inpatient children. Study Design This study uses a national cross-sectional cohort to analyze children with and without DS undergoing tonsillectomy with or without adenoidectomy. Setting 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database. Subjects and Methods The database was analyzed for postoperative hemorrhage and respiratory compromise, length of stay, and total charges of hospital stay. These outcomes were compared between patients with DS vs patients without DS. Results In total, 7512 patients were identified who underwent tonsillectomy: 7159 patients without DS and 353 patients with DS. The non-DS group was younger with a median age of 3 years (range, 0-18) compared with a DS median age of 4 years (range, 0-20), P = .004. The DS group had a significant increase in postoperative hemorrhage compared with non-DS (10 [2.8%] vs 87 [1.2%], respectively), P = .024. However, the DS and non-DS groups were comparable for respiratory complications (5 [1.4%] vs 106 [1.5%], respectively), P = .922. Median length of stay was significantly increased in the DS group (1 [interquartile range (IQR), 1-3]) compared with the non-DS group (1 [IQR, 1-2]), P < .001. Median charges for hospital stay totaled $17,451 (IQR, $11,901-$24,949) for the DS group compared with $14,395 (IQR, $9739-$21,890) for the non-DS group, P < .001. Conclusion Across the United States, children with DS hospitalized for tonsillectomy have an increased length of stay and cost of care. These data also suggest an increased risk of postoperative hemorrhage during the initial admission without an increased risk of respiratory complications.
在全国住院儿童样本中，描述唐氏综合征（DS）患儿接受扁桃体切除术后的费用、住院时间及术后出血发生率。研究设计：本研究采用全国性横断面队列研究，分析患有和未患有DS的儿童接受或未接受腺样体切除术的扁桃体切除术情况。研究背景：2012年医疗保健成本与利用项目儿童住院数据库。研究对象与方法：分析数据库中术后出血、呼吸功能不全、住院时间及住院总费用情况。比较DS患儿与非DS患儿的这些结局。结果：共确定7512例接受扁桃体切除术的患儿：7159例非DS患儿和353例DS患儿。非DS组患儿年龄更小，中位年龄为3岁（范围0 - 18岁），而DS组患儿中位年龄为4岁（范围0 - 20岁），P = 0.004。与非DS组相比，DS组术后出血显著增加（分别为10例[2.8%]和87例[1.2%]），P = 0.024。然而，DS组和非DS组呼吸并发症情况相当（分别为5例[1.4%]和106例[1.5%]），P = 0.922。与非DS组（1天[四分位间距（IQR），1 - 2天]）相比，DS组中位住院时间显著延长（1天[IQR，1 - 3天]），P < 0.001。DS组住院中位费用总计17,451美元（IQR，11,901 - 24,949美元），而非DS组为14,395美元（IQR，9739 - 21,890美元），P < 0.001。结论：在美国，因扁桃体切除术住院的DS患儿住院时间延长且护理费用增加。这些数据还表明，首次住院期间术后出血风险增加，而呼吸并发症风险未增加。
