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小儿鼻整形术:一项国家外科质量改进计划分析。

Pediatric Rhinoplasty: A national surgical quality improvement program analysis.

作者信息

Kamil Rebecca J, Roxbury Christopher, Boss Emily

机构信息

Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland.

Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

出版信息

Laryngoscope. 2019 Feb;129(2):494-499. doi: 10.1002/lary.27304. Epub 2018 Oct 16.

Abstract

OBJECTIVES

Rhinoplasty is commonly performed in children with congenital anomalies and resultant nasal deformity causing airway obstruction. Little is known regarding patient factors or perioperative sequelae. We define demographic characteristics and perioperative complications for children undergoing rhinoplasty within a large national cohort.

STUDY DESIGN

Retrospective cohort study of children aged ≤ 18 years undergoing rhinoplasty utilizing data from the 2012 to 2015 American College of Surgeons National Surgery Quality Improvement Program-Pediatric public use file.

METHODS

All children who underwent rhinoplasty were identified. Postoperative complications were defined as 30-day postoperative infection, unplanned readmission and reoperation, and death. Multivariate logistic regression was used to identify predictors of complications. Subgroup analysis was performed based on child age (age < 5 years vs. 5-13 years vs. ≥ 14 years).

RESULTS

Of 1,378 children undergoing rhinoplasty, 21(1.52%) children experienced complications, with the most common being unplanned readmission. Younger children were more likely to experience complications (3.79% aged < 5 years vs. 0.66% aged ≥ 14 years; P = 0.001). Using multivariate logistic regression analysis, we observed a 61% decreased odds of complication with each age group (odds ratio 0.39, 95% confidence interval 0.19, 0.77; P = 0.007). Younger children were more likely to be male (56.2% male aged < 5 years vs. 46.6% male aged ≥ 14 years; P = 0.011), have developmental delay (11.7% aged < 5 years vs. 3.65% aged ≥ 14 years; P < 0.001), and have craniofacial abnormalities (73.2% aged < 5 years vs. 42.1% aged ≥ 14 years; P < 0.001).

CONCLUSION

Children undergoing rhinoplasty experience few major complications, with the most common being unplanned readmission. Younger children are at greater risk and are more likely to be male with craniofacial abnormalities.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:494-499, 2019.

摘要

目的

鼻整形术常用于患有先天性异常并导致鼻畸形从而引起气道阻塞的儿童。关于患者因素或围手术期后遗症,我们所知甚少。我们在一个大型全国队列中定义了接受鼻整形术儿童的人口统计学特征和围手术期并发症。

研究设计

利用2012年至2015年美国外科医师学会国家外科质量改进计划 - 儿科公开使用文件中的数据,对年龄≤18岁接受鼻整形术的儿童进行回顾性队列研究。

方法

确定所有接受鼻整形术的儿童。术后并发症定义为术后30天感染、计划外再入院和再次手术以及死亡。采用多因素逻辑回归分析来确定并发症的预测因素。根据儿童年龄(年龄<5岁 vs. 5 - 13岁 vs.≥14岁)进行亚组分析。

结果

在1378例接受鼻整形术的儿童中,21例(1.52%)出现并发症,最常见的是计划外再入院。年龄较小的儿童更易出现并发症(年龄<5岁的儿童为3.79%,年龄≥14岁的儿童为0.66%;P = 0.001)。通过多因素逻辑回归分析,我们观察到每个年龄组并发症发生几率降低61%(比值比0.39,95%置信区间0.19,0.77;P = 0.007)。年龄较小的儿童更可能为男性(年龄<5岁的儿童中男性占56.2%,年龄≥14岁的儿童中男性占46.6%;P = 0.011),有发育迟缓(年龄<5岁的儿童为11.7%,年龄≥14岁的儿童为3.65%;P<0.001),以及有颅面异常(年龄<5岁的儿童为73.2%,年龄≥14岁的儿童为42.1%;P<0.001)。

结论

接受鼻整形术的儿童很少发生严重并发症,最常见的是计划外再入院。年龄较小的儿童风险更高,且更可能为男性并伴有颅面异常。

证据水平

4 《喉镜》,2019年,第129卷,第494 - 499页

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