Schwartz Angelina L, Nourian Maziar M, Bucher Brian T
Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, United States.
Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, United States.
J Pediatr Surg. 2019 Apr;54(4):640-644. doi: 10.1016/j.jpedsurg.2018.06.004. Epub 2018 Jun 9.
Retained foreign bodies discovered after surgery are documented as Agency for Health Care Quality and Research Patient Safety Indicators. Our goal was to identify pediatric patient and procedure risk factors and outcomes associated with RFB based on AHRQ Definitions.
We performed a retrospective case-control study of children with RFB using the PHIS database. Patients were defined as having RFB based on the AHRQ PSI definition. Controls were matched in a 5:1 ratio on age, procedure date, and hospital. Our primary outcome was the presence of RFB. Secondary outcomes included hospital length of stay and mortality.
Patients with RFB often underwent emergent procedures, experienced one or more chronic conditions, and required ICU admission or mechanical ventilation. Musculoskeletal procedures contribute the largest numbers of RFB (30.4%), but interventional radiology procedures had higher odds of having RFB (AOR 7.88, p < 0.0001). After multivariate adjustment, children with RFB required 4 more days of hospitalization (p < .001), but there was no difference in mortality (p = .579).
The implications of our study include identifying which administrative flags can be used to identify children at higher risks for RFB. Early identification of at-risk patients and prevention are key towards addressing the primary problem and corresponding sequela of RFB.
Prognostic Study Level III.
手术后发现的残留异物被记录为医疗保健质量与研究机构患者安全指标。我们的目标是根据美国医疗保健研究与质量局（AHRQ）的定义，确定与残留异物相关的儿科患者、手术风险因素及结果。
我们使用儿科健康信息系统（PHIS）数据库对残留异物患儿进行了一项回顾性病例对照研究。根据AHRQ患者安全指标（PSI）定义将患者定义为有残留异物。对照组按年龄、手术日期和医院以5:1的比例进行匹配。我们的主要结局是残留异物的存在情况。次要结局包括住院时间和死亡率。
有残留异物的患者常接受急诊手术，患有一种或多种慢性病，且需要入住重症监护病房（ICU）或进行机械通气。肌肉骨骼手术导致的残留异物数量最多（30.4%），但介入放射学手术出现残留异物的几率更高（调整后比值比[AOR]为7.88，p<0.0001）。多因素调整后，有残留异物的儿童住院时间延长4天（p<0.001），但死亡率无差异（p=0.579）。
我们研究的意义包括确定哪些管理标识可用于识别残留异物风险较高的儿童。早期识别高危患者并进行预防是解决残留异物主要问题及相应后遗症的关键。
预后研究III级。
