Garcia Alejandro V, Ladd Mitchell R, Crawford Todd, Culbreath Katherine, Tetteh Oswald, Alaish Samuel M, Boss Emily F, Rhee Daniel S
Department of Surgery, Johns Hopkins School of Medicine, 1800 Orleans St., Baltimore, MD, 21287, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Pediatr Surg Int. 2018 Aug;34(8):837-844. doi: 10.1007/s00383-018-4298-1. Epub 2018 Jun 18.
To evaluate the perioperative risk factors for 30-day complications of the Kasai procedure in a large, cross-institutional, modern dataset.
The 2012-2015 National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing the Kasai procedure. Patients' characteristics were compared by perioperative blood transfusions and 30-day outcomes, including complications, reoperations, and readmissions. Multivariable logistic regression was used to identify risk factors predictive of outcomes. Propensity matching was performed for perioperative blood transfusions to evaluate its effect on outcomes.
190 children were included with average age of 62 days. Major cardiac risk factors were seen in 6.3%. Perioperative blood transfusions occurred in 32.1%. The 30-day post-operative complication rate was 15.8%, reoperation 6.8%, and readmission 15.3%. After multivariate analysis, perioperative blood transfusions (OR 3.94; p < 0.01) and major cardiac risk factors (OR 7.82; p < 0.01) were found to increase the risk of a complication. Perioperative blood transfusion (OR 4.71; p = 0.01) was associated with an increased risk of reoperation. Readmission risk was increased by prematurity (OR 3.88; p = 0.04) and 30-day complication event (OR 4.09; p = 0.01). After propensity matching, perioperative blood transfusion was associated with an increase in complications (p < 0.01) and length of stay (p < 0.01).
Major cardiac risk factors and perioperative blood transfusions increase the risk of post-operative complications in children undergoing the Kasai procedure. Further research is warranted in the perioperative use of blood transfusions in this population.
IV.
在一个大型、跨机构的现代数据集中评估肝门空肠吻合术30天并发症的围手术期危险因素。
使用2012 - 2015年国家外科质量改进计划儿科数据库来识别接受肝门空肠吻合术的患者。通过围手术期输血情况和30天结局（包括并发症、再次手术和再次入院）对患者特征进行比较。采用多变量逻辑回归来识别预测结局的危险因素。对围手术期输血进行倾向匹配以评估其对结局的影响。
纳入190名儿童，平均年龄62天。6.3%的患儿存在主要心脏危险因素。围手术期输血发生率为32.1%。术后30天并发症发生率为15.8%，再次手术率为6.8%，再次入院率为15.3%。多变量分析后发现，围手术期输血（比值比[OR] 3.94；p < 0.01）和主要心脏危险因素（OR 7.82；p < 0.01）会增加并发症风险。围手术期输血（OR 4.71；p = 0.01）与再次手术风险增加相关。早产（OR 3.88；p = 0.04）和30天并发症事件（OR 4.09；p = 0.01）会增加再次入院风险。倾向匹配后，围手术期输血与并发症增加（p < 0.01）和住院时间延长（p < 0.01）相关。
主要心脏危险因素和围手术期输血会增加接受肝门空肠吻合术儿童的术后并发症风险。有必要对该人群围手术期输血的使用进行进一步研究。
IV级
