Papandria Dominic, Sebastião Yuri V, Deans Katherine J, Diefenbach Karen A, Minneci Peter C
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
J Surg Res. 2018 Nov;231:186-194. doi: 10.1016/j.jss.2018.05.054. Epub 2018 Jun 21.
The objective of this study was to identify ranges of postoperative length of stay (LOS) for common pediatric procedures using a large multi-institutional database.
A retrospective analysis of the most frequently performed general surgical procedures in the ACS-NSQIP Pediatric (2013-2015) was performed. These included laparoscopic appendectomy (LA), laparoscopic cholecystectomy, laparoscopic gastrostomy, laparoscopic esophagogastric fundoplication (LF), thoracoscopic repair of pectus excavatum (TPE), open appendectomy (OA), enterostomy closure (OEC), gastrostomy closure (OGC), and bowel resection (OBR). Patients aged <6 mo or >18 y, operations with major concurrent procedures, same-day discharges, operations performed >2 d after admission, and inpatient deaths were excluded. Postoperative LOS was examined for each procedure, including multivariable analysis of risk factors for postoperative LOS > 75th percentile.
A total of 29,557 cases were identified and included procedure subgroups ranging from 505 (OBR) to 19,260 (LA) cases. Procedure-specific median postoperative LOS (75th percentile; 90th percentile) were LA 1 d (2 d; 5 d); laparoscopic cholecystectomy 1 d (1 d; 2 d); laparoscopic gastrostomy 2 d (2 d, 4 d); laparoscopic fundoplication 3 d (4 d, 6 d); thoracoscopic repair of pectus excavatum 4 d (5 d, 6 d); OA 3 d (6 d, 9 d); OEC 4 d (6 d, 10 d); OGC 1 d (1 d, 2 d); and OBR 6 d (10 d, 20 d). Preoperative risk factors for high postoperative LOS varied by procedure and included patient demographics, admission factors, case characteristics, and comorbidities.
The range of postoperative LOS and risk factors for high postoperative LOS for commonly performed procedures varied considerably. These results may be a useful reference for benchmarking and resource utilization analyses at the institutional and health systems levels.
本研究的目的是使用一个大型多机构数据库确定常见儿科手术术后住院时间（LOS）的范围。
对美国外科医师学会国家外科质量改进计划儿科数据库（2013 - 2015年）中最常实施的普通外科手术进行回顾性分析。这些手术包括腹腔镜阑尾切除术（LA）、腹腔镜胆囊切除术、腹腔镜胃造口术、腹腔镜食管胃底折叠术（LF）、胸腔镜漏斗胸修复术（TPE）、开放性阑尾切除术（OA）、肠造口关闭术（OEC）、胃造口关闭术（OGC）和肠切除术（OBR）。年龄小于6个月或大于18岁的患者、同期进行重大手术的患者、当日出院的患者、入院后2天以上进行的手术以及住院死亡患者被排除。对每种手术的术后住院时间进行了检查，包括对术后住院时间超过第75百分位数的危险因素进行多变量分析。
共识别出29,557例病例，各手术亚组病例数从505例（OBR）到19,260例（LA）不等。各手术特定的术后住院时间中位数（第75百分位数；第90百分位数）分别为：LA 1天（2天；5天）；腹腔镜胆囊切除术1天（1天；2天）；腹腔镜胃造口术2天（2天，4天）；腹腔镜胃底折叠术3天（4天，6天）；胸腔镜漏斗胸修复术4天（5天，6天）；OA 3天（6天，9天）；OEC 4天（6天，10天）；OGC 1天（1天，2天）；OBR 6天（10天，20天）。术后住院时间长的术前危险因素因手术而异，包括患者人口统计学特征、入院因素、病例特点和合并症。
常见手术术后住院时间范围以及术后住院时间长的危险因素差异很大。这些结果可能为机构和卫生系统层面的基准比较和资源利用分析提供有用的参考。
