腺样体扁桃体切除术治疗后阻塞性睡眠呼吸暂停患儿的入院标准：考虑费用因素。
Admission Criteria for Children With Obstructive Sleep Apnea After Adenotonsillectomy: Considerations for Cost.
机构信息
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
出版信息
J Clin Sleep Med. 2017 Dec 15;13(12):1463-1472. doi: 10.5664/jcsm.6850.
STUDY OBJECTIVES
Postoperative respiratory complications (PRCs) are common among children with obstructive sleep apnea (OSA) after adenotonsillectomy. We analyzed postoperative admission guidelines to determine which optimally balanced patient safety and cost.
METHODS
Retrospective study of children aged 12 years or younger undergoing adenotonsillectomy for OSA after polysomnography at a tertiary academic care center over 2 years. Demographics, medical History, and hospital course were collected. Advanced Excel modeling was used to assess the number of children with PRCs identified with guideline admission criteria and to validate the significance of these findings in our patient population with logistic regression.
RESULTS
Six hundred thirty children were included; 116 had documented PRCs. Children with PRCs were younger ( = .024) and more frequently male ( = .012). There were no significant differences in race ( = .411) or obesity ( = .265). More children with PRCs had an apnea-hypopnea index (AHI) > 24 events/h ( < .001). Following guidelines from the American Academy of Pediatrics, American Academy of Otolaryngology - Head and Neck Surgery, and Nationwide Children's Hospital, 82%, 87%, and 99% of children with PRCs would be identified, costing $535,962, $647,165, and $1,053,694 for admission, respectively. Using a non-validated, forced model to refine predictors described in published guidelines, our model would have identified 95% of children with one or more PRCs, with a moderate cost.
CONCLUSIONS
Current admission guidelines attempt to identify children with OSA at high risk for PRCs after adenotonsillectomy; however, none consider the economic cost to the health care system. We present a comparison of the number of patients identified with PRCs after adenotonsillectomy and the cost of expected admissions using currently published guidelines.
COMMENTARY
A commentary on this article appears in this issue on page 1371.
研究目的
扁桃体腺样体切除术（adenotonsillectomy）后，阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）患儿常发生术后呼吸系统并发症（postoperative respiratory complications，PRCs）。本研究旨在分析术后入院指导原则，以确定何种方法能在保证患者安全的基础上实现成本效益最大化。
方法
本研究为回顾性研究，对象为在一家三级学术医疗中心接受多导睡眠图（polysomnography）检查并确诊 OSA 后行扁桃体腺样体切除术的 12 岁及以下儿童，研究时间为 2 年。收集患者的人口统计学、病史和住院情况等数据。采用高级 Excel 模型评估符合入院指导原则的 PRC 患儿数量，并通过逻辑回归验证这些发现对本患者人群的意义。
结果
共纳入 630 例患儿，其中 116 例患儿有 PRC 记录。发生 PRC 的患儿年龄更小（P =.024）且更常为男性（P =.012）。两组患儿在种族（P =.411）和肥胖程度（P =.265）方面无显著差异。PRC 患儿的呼吸暂停低通气指数（apnea-hypopnea index，AHI）＞24 次/小时的比例更高（P＜.001）。根据美国儿科学会（American Academy of Pediatrics）、美国耳鼻咽喉头颈外科学会（American Academy of Otolaryngology-Head and Neck Surgery）和全国儿童医院（Nationwide Children's Hospital）的指南，82%、87%和 99%的 PRC 患儿将被识别出，相应的入院费用分别为 535962 美元、647165 美元和 1053694 美元。使用非验证性的、强制性模型来优化已发表指南中描述的预测因素，我们的模型将能识别出 95%有一个或多个 PRC 的患儿，但费用较高。
结论
目前的入院指导原则旨在识别扁桃体腺样体切除术后发生 PRCs 风险较高的 OSA 患儿；然而，这些指南均未考虑到对医疗保健系统的经济成本。本研究比较了使用目前已发表的指南识别扁桃体腺样体切除术后发生 PRC 的患儿数量和预期入院费用。
评论
本篇文章的评论见本期第 1371 页。
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