Ramakrishnan Karthik V, Zurakowski David, Pastor William, Jonas Richard A, Sinha Pranava
1 Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
2 Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):539-545. doi: 10.1177/2150135118780615.
Compare the early outcomes and hospital charges of early primary repair and systemic-to-pulmonary artery shunt for neonates and young infants (≤90 days of age) with tetralogy of Fallot using data from the Pediatric Health Information System database.
The Pediatric Health Information System database was queried for patients <90 days of age with primary diagnosis of tetralogy of Fallot who underwent nonelective surgical repair or palliation between January 2008 and December 2014. The initial cohort of 821 patients (group 1 early primary repair, N = 554; group 2 systemic-to-pulmonary artery shunt, N = 267) was propensity score matched (248 patients in each group) to account for baseline imbalances in age and prostaglandin use.
Comparison of unmatched groups revealed younger age and higher incidence of extracardiac anomalies ( P = .02) and prematurity ( P = .04) in group 2. Mortality was comparable between the groups (group 1: 20 [4%] of 554 vs group 2: 11 [4%] of 267, P = .74). Irrespective of the type of procedure, prematurity (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.5-7.4) and extracardiac anomalies (OR = 2.5, 95% CI: 1.2-5.3) were independent risk factors for mortality. Propensity score-matched analysis revealed no significant differences in patient mortality ( P = 1), duration of ventilation ( P = .64), hospital length of stay ( P = .69), or hospital charges ( P = .08) between the two groups.
Outcomes and hospital charges associated with nonelective early primary repair are comparable to systemic-to-pulmonary artery shunt in symptomatic patients <90 days old with tetralogy of Fallot.
利用儿科健康信息系统数据库的数据，比较法洛四联症新生儿及小婴儿（≤90日龄）早期一期修复术与体肺分流术的早期疗效及住院费用。
查询儿科健康信息系统数据库，找出2008年1月至2014年12月期间初次诊断为法洛四联症且接受非选择性手术修复或姑息治疗的90日龄以下患者。初始队列包括821例患者（第1组为早期一期修复术，N = 554；第2组为体肺分流术，N = 267），通过倾向评分匹配（每组248例患者）以消除年龄和前列腺素使用方面的基线不平衡。
未匹配组的比较显示，第2组患者年龄更小，心外畸形发生率更高（P = 0.02），早产发生率更高（P = 0.04）。两组死亡率相当（第1组：554例中有20例[4%]，第2组：267例中有11例[4%]，P = 0.74）。无论手术类型如何，早产（比值比[OR] = 3.3，95%置信区间[CI]：1.5 - 7.4）和心外畸形（OR = 2.5，95% CI：1.2 - 5.3）都是死亡的独立危险因素。倾向评分匹配分析显示，两组患者的死亡率（P = 1）、通气时间（P = 0.64）、住院时间（P = 0.69）或住院费用（P = 0.08）无显著差异。
对于症状性90日龄以下法洛四联症患者，非选择性早期一期修复术的疗效及住院费用与体肺分流术相当。
