Hong Charles R, Fullerton Brenna S, Han Sam M, Morrow Kate A, Edwards Erika M, Soll Roger F, Jaksic Tom, Horbar Jeffrey D, Modi Biren P
Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Vermont Oxford Network, Burlington, VT, USA.
J Pediatr Surg. 2019 Jan;54(1):65-69. doi: 10.1016/j.jpedsurg.2018.10.034. Epub 2018 Oct 5.
Gastroschisis, a surgical condition requiring complex interdisciplinary care, may benefit from treatment at higher volume centers. Recent studies on surgical volume and outcomes have conflicting findings.
Data were collected prospectively on newborns ≥1500 g with gastroschisis born 2009-2015, admitted to 159 US centers, and separated into terciles based on number of annual gastroschisis repairs. Infants transferred after gastroschisis repair were excluded.
There were 4663 infants included: 307 from 53 low, 1201 from 55 medium, and 3155 from 51 high volume centers. Infants at high volume centers had higher rates of intestinal atresia (P = 0.04) and outborn status (P < 0.0001). Outborn infants (N = 1134) had higher rates of gastrostomy/jejunostomy placement (P < 0.001). Mortality was universally low (2.0% low, 2.4% medium, and 1.7% high; 2.0% outborn and 1.9% inborn). On multivariate analysis, mortality, sepsis rates, and length of stay did not differ by center volume. Outborn status was associated with longer length of stay (P = 0.001), not mortality or sepsis.
Infant characteristics and management vary based on gastroschisis surgical volume and transfer status. Center volume and early transfers were not associated with mortality. Further investigation to identify subsets of gastroschisis infants who would benefit from care at higher volume centers is warranted.
Prognosis study.
Level II.
腹裂是一种需要复杂多学科护理的外科疾病，在手术量较大的中心接受治疗可能会受益。近期关于手术量与治疗结果的研究结果相互矛盾。
前瞻性收集2009年至2015年出生、体重≥1500克且患有腹裂的新生儿数据，这些新生儿入住美国159个中心，并根据每年腹裂修复手术数量分为三个等级。腹裂修复术后转诊的婴儿被排除。
共纳入4663例婴儿：53个低手术量中心的307例、55个中等手术量中心的1201例、51个高手术量中心的3155例。高手术量中心的婴儿肠道闭锁发生率较高（P = 0.04），且外院出生比例较高（P < 0.0001）。外院出生的婴儿（n = 1134）胃造口术/空肠造口术置入率较高（P < 0.001）。总体死亡率较低（低手术量中心为2.0%，中等手术量中心为2.4%，高手术量中心为1.7%；外院出生婴儿为2.0%，本院出生婴儿为1.9%）。多因素分析显示，死亡率、败血症发生率和住院时间在不同手术量中心之间无差异。外院出生与住院时间延长相关（P = 0.001），与死亡率或败血症无关。
婴儿特征和管理因腹裂手术量和转诊状态而异。中心手术量和早期转诊与死亡率无关。有必要进一步研究确定哪些腹裂婴儿亚组能从高手术量中心的护理中受益。
预后研究。
二级。
