From the Department of Pediatric Surgery, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Anesth Analg. 2019 Mar;128(3):525-532. doi: 10.1213/ANE.0000000000003386.
Postoperatively, young infants are admitted overnight in view of the risk for respiratory complications such as desaturation and apnea. This risk seems much lower than previously reported. Until what age this risk persists, and which infants might actually qualify for day-care treatment, is unknown.
We retrospectively reviewed medical charts from preterm infants <45 weeks postconceptional age (PCA), 45-60 weeks PCA, and term infants <3 months admitted overnight after inguinal hernia repair, from January 2011 to December 2015 in a large tertiary children's hospital. Postoperative complications (divided into respiratory, circulatory, neurologic, and other), recurrence, and reoperation were documented and compared between groups.
Medical charts of 485 patients were reviewed. Postoperative respiratory complications (mainly desaturations or apnea) had been documented for 27 of 76 (35.5%) preterm infants <45 weeks PCA, for 13 of 221 (5.9%) preterm infants 45-60 weeks PCA, and for 3 of 188 (1.6%) term infants (P < .001). An analysis of the 221 preterm infants 45-60 weeks PCA showed statistically significantly more respiratory complications in 76 infants with a respiratory history (eg, bronchopulmonary dysplasia) compared with the others (respectively 13.2% vs 0.7%; P < .001). In these infants, lower gestational age at the time of surgery was statistically significantly predictive for the development of respiratory complications (odds ratio [OR], 0.68 [95% confidence interval {CI}, 0.52-0.89]; P = .005), but respiratory history (OR, 3.50 [0.34-36.28]; P = .294) and American Society of Anesthesiologists (ASA) physical status (OR, 1.54 [95% CI, 0.31-7.65]; P = .598 for ASA physical status II and OR, 6.11 [95% CI, 0.76-49.05]; P = .089 for ASA physical status III) were not predictive.
Incidence of postoperative respiratory complications is high in preterm infants <45 weeks PCA requiring postoperative overnight saturation and heart rate monitoring. Incidence of postoperative complications in preterm born infants 45-60 weeks PCA varies. Gestational age and possibly presence of respiratory history can be used to estimate the need for overnight admission in these infants. Postoperative respiratory complications after inguinal hernia repair in ASA physical status I and II term born infants >1 month of age are uncommon, which justifies day-care admission for this type of surgical procedure.
由于存在呼吸并发症（如血氧饱和度下降和呼吸暂停）的风险，术后，小婴儿需要住院过夜。但这种风险似乎比之前报道的要低。目前尚不清楚这种风险持续到什么年龄，哪些婴儿实际上有资格接受日间护理治疗。
我们回顾性地查阅了 2011 年 1 月至 2015 年 12 月期间，在一家大型儿科三甲医院行腹股沟疝修补术的＜45 周（校正后胎龄）、45-60 周和＜3 个月的早产儿和足月婴儿的住院记录。记录术后并发症（分为呼吸、循环、神经和其他）、复发和再次手术，并在各组之间进行比较。
共回顾了 485 例患儿的病历。＜45 周（校正后胎龄）的 76 例早产儿中（35.5%）有 27 例发生术后呼吸并发症（主要为血氧饱和度下降或呼吸暂停），221 例 45-60 周（校正后胎龄）早产儿中有 13 例（5.9%），188 例足月婴儿中有 3 例（1.6%）（P＜0.001）。对 221 例 45-60 周（校正后胎龄）早产儿的分析显示，与无呼吸系统病史的婴儿相比（如支气管肺发育不良），有呼吸系统病史的婴儿（13.2%比 0.7%）的呼吸并发症发生率明显更高（P＜0.001）。在这些婴儿中，手术时的胎龄较低与呼吸并发症的发生呈统计学显著相关（比值比[OR]，0.68[95%置信区间{CI}，0.52-0.89]；P=0.005），但呼吸系统病史（OR，3.50[0.34-36.28]；P=0.294）和美国麻醉医师协会（ASA）身体状况（OR，1.54[95%CI，0.31-7.65]；ASA 身体状况 II 级，P=0.598）和（OR，6.11[95%CI，0.76-49.05]；ASA 身体状况 III 级，P=0.089）均无预测作用。
需要术后过夜监测血氧饱和度和心率的＜45 周（校正后胎龄）早产儿术后呼吸并发症发生率较高。45-60 周（校正后胎龄）早产儿术后并发症的发生率存在差异。胎龄和可能存在的呼吸系统病史可用于估计这些婴儿的住院需求。ASA 身体状况 I 级和 II 级的＞1 个月龄足月婴儿术后腹股沟疝修补术的呼吸并发症罕见，这支持日间护理入院治疗。
