Crowson Matthew G, Cheng Jeffrey
Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, NC, USA.
Pediatric Otolaryngology, Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Int J Pediatr Otorhinolaryngol. 2018 May;108:132-136. doi: 10.1016/j.ijporl.2018.02.043. Epub 2018 Mar 1.
To examine preoperative risk factors, postoperative 30-day outcomes and adverse events of acute mastoiditis using a national pediatric surgical database.
We explored our objectives using a cross-sectional analysis of a hospital-based reporting system database. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) pediatric database was used to identify surgical encounters for the treatment of acute mastoiditis from 2012 to 2015. Patient demographics, co-morbidities, laboratory values, surgical details, complications, and outcomes were tabulated. Linear regression was used to determine predictors of prolonged hospital stay based on pre-operative, surgical and outcome variables.
113 patients with acute mastoiditis were identified from with mean age of 7.8 years. Mastoidectomy was the most common index procedure performed (44; 34%). Average hospital stay length was 5.2 days. No patients died within 30 days. 4 (3.1%) patients required readmission, and 9 (6.9%) required unplanned subsequent operative procedures. Pre-operative presence of sepsis or systemic inflammatory response syndrome (SIRS; p = 0.03), and unplanned additional procedures were associated with a prolonged hospital stay (p = 0.03), but age, gender, race, and pre-operative morbidities were not (p > 0.05).
Contemporary surgical management of acute mastoiditis in children appears to be safe. Mortality is rare and has been potentially eliminated as a complication. Rates of pre-operative systemic infection were very high, despite current antibiotic utilization trends. Opportunities for quality improvement exist to investigate how to decrease rates of preoperative sepsis, limit readmissions, and unplanned re-operations. The role of mastoidectomy appears prominent, as it was used in about two-thirds of cases.
利用全国儿科手术数据库研究急性乳突炎的术前危险因素、术后30天结局及不良事件。
我们通过对基于医院的报告系统数据库进行横断面分析来探究我们的目标。使用美国外科医师学会国家外科质量改进计划（NSQIP）儿科数据库来识别2012年至2015年治疗急性乳突炎的手术病例。将患者的人口统计学特征、合并症、实验室检查值、手术细节、并发症及结局制成表格。基于术前、手术及结局变量，采用线性回归确定住院时间延长的预测因素。
共识别出113例急性乳突炎患者，平均年龄7.8岁。乳突切除术是最常见的主要手术（44例；34%）。平均住院时间为5.2天。30天内无患者死亡。4例（3.1%）患者需要再次入院，9例（6.9%）需要进行计划外的后续手术。术前存在脓毒症或全身炎症反应综合征（SIRS；p = 0.03）以及计划外的额外手术与住院时间延长相关（p = 0.03），但年龄、性别、种族及术前合并症则无此关联（p > 0.05）。
当代儿童急性乳突炎的手术治疗似乎是安全的。死亡率罕见，且作为一种并发症可能已被消除。尽管有当前抗生素使用趋势，但术前全身感染率仍非常高。存在质量改进的机会来研究如何降低术前脓毒症发生率、减少再次入院及计划外再次手术。乳突切除术的作用似乎很突出，因为约三分之二的病例使用了该手术。
4级。
