1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
2 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Otolaryngol Head Neck Surg. 2019 Feb;160(2):326-331. doi: 10.1177/0194599818800470. Epub 2018 Sep 18.
(1) Describe outcomes of bronchoscopy with foreign body removal among children on the basis of a large standardized multi-institutional data set. (2) Identify factors associated with 30-day adverse events.
Cross-sectional analysis of a US national database.
Public data set from the ACS NSQIP-P (American College of Surgeons National Surgical Quality Improvement Program-Pediatric) from 2012 to 2015.
Children <18 years old who underwent bronchoscopy with removal of foreign body were identified. Patient demographics, comorbidities, hospitalization factors, surgical characteristics, and 30-day postoperative adverse events, including complication and readmission, were analyzed. Multivariate logistic regression identified predictive factors for postoperative complications and prolonged length of stay.
A total of 275 children underwent bronchoscopic foreign body removal (n = 165 male, 60%; n = 75 nonwhite and/or Hispanic, 27%; mean age, 3.5 years [range, 0.63-17.9; median, 2.0]). Adverse events occurred among 10 children (4%). Seven had pulmonary-related complications, and 1 patient died. Three patients were readmitted; there were no reoperations. On multivariate analysis, preoperative pulmonary disease or need for pulmonary support (odds ratio [OR], 6.42; P = .04) predicted postoperative complications. Preoperative pulmonary compromise (OR, 8.10; P < .01), American Society of Anesthesiologists class 3 or 4 (OR, 4.13; P < .01), and prolonged operative time (OR, 3.05; P = .01) were associated with prolonged hospital stay.
Bronchoscopy for retrieval of foreign body among children has an overall low incidence of 30-day adverse events. Children with preoperative pulmonary compromise have a significantly higher risk of postoperative complications. These findings may be applied to optimize perioperative care and counsel parents and families.
（1）根据大型标准化多机构数据集，描述儿童支气管镜异物取出的结果。（2）确定与 30 天不良事件相关的因素。
美国外科医师学会国家外科质量改进计划小儿数据库（ACS NSQIP-P）的横断面分析。
2012 年至 2015 年的公共数据集。
确定接受支气管镜异物取出术的<18 岁儿童。分析患者的人口统计学、合并症、住院因素、手术特征以及 30 天术后不良事件，包括并发症和再入院。多变量逻辑回归确定术后并发症和延长住院时间的预测因素。
共 275 例儿童行支气管镜异物取出术（165 例男性，60%；75 例非白人和/或西班牙裔，27%；平均年龄 3.5 岁[范围：0.63-17.9；中位数：2.0]）。10 例患儿发生不良事件（4%）。7 例发生肺部相关并发症，1 例死亡。3 例患儿再入院；无再次手术。多变量分析显示，术前肺部疾病或需要肺部支持（比值比[OR]，6.42；P =.04）预测术后并发症。术前肺部功能不全（OR，8.10；P <.01）、美国麻醉师协会（ASA）分级 3 或 4 级（OR，4.13；P <.01）和手术时间延长（OR，3.05；P =.01）与住院时间延长相关。
儿童支气管镜异物取出术总体 30 天不良事件发生率较低。术前肺部功能不全的儿童术后并发症风险显著增加。这些发现可用于优化围手术期护理并向家长和家属提供咨询。
