Harounian Jonathan A, Patel Vijay A, Carr Michele M
Department of Otolaryngology - Head and Neck Surgery, Temple University Hospital, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
Division of Otolaryngology - Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
Int J Pediatr Otorhinolaryngol. 2019 Jan;116:125-129. doi: 10.1016/j.ijporl.2018.10.038. Epub 2018 Oct 28.
To identify risk factors and determine perioperative morbidity of children under 2 years of age undergoing cervical abscess drainage.
Patients who underwent cervical abscess drainage 1-18 years of age were queried via the ACS-National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015). Analyzed outcomes include length of stay, operative time, readmission/reoperation rate, and postoperative complications.
A total of 2181 children were identified, 858 were <2 (51.5% male) and 1323 were >2 years (57.1% male) (p = 0.011). The younger cohort was found to undergo more lateral approaches for cervical abscess drainage whereas the older cohort was found to undergo more intraoral approaches for pharyngeal abscess drainage (p < 0.001), suggesting a difference in abscess location related to age at clinical presentation. The younger cohort was also found to have a higher preoperative white blood cell count (20.7 vs. 17.5, p < 0.001) but no significant difference in preoperative fulminant sepsis was observed. Younger children were found to have both a longer wait-time until surgery (1.4 vs. 1.1 days, p = 0.003) and a prolonged length of stay (LOS) (4.3 vs. 3.4 days, p < 0.001). Operative time was found to be lower in the younger cohort (18.4 vs. 21.5 min, p = 0.003), Finally, the younger cohort was found to have an increased incidence and duration of postoperative mechanical ventilation (63 vs. 41, and 0.4 vs. 0.1 days, respectively, p < 0.001.). There were no differences in post-op complications (wound infection, dehiscence, pneumonia, reintubation, and reoperation/readmission). Linear regression for LOS showed that major contributors were operative time, days of postop ventilation, and days from admission to surgery with R = 0.700.
Children under 2 years of age have longer LOS that may in part be due to a greater likelihood of postoperative ventilation and a delay in operative intervention, despite having surgical approaches associated with a shorter LOS. They are no more prone to complications than are older children. Recognition of these critical factors plays a role in optimizing perioperative risk assessment and procedural planning within this patient population.
确定2岁以下儿童行颈部脓肿引流术的危险因素，并确定围手术期发病率。
通过美国外科医师学会-国家外科质量改进计划-儿科（NSQIP-P）数据库（2012 - 2015年）查询1 - 18岁行颈部脓肿引流术的患者。分析的结果包括住院时间、手术时间、再入院/再次手术率和术后并发症。
共识别出2181名儿童，其中858名年龄<2岁（男性占51.5%），1323名年龄>2岁（男性占57.1%）（p = 0.011）。发现年龄较小的队列行颈部脓肿引流术采用外侧入路的更多，而年龄较大的队列行咽脓肿引流术采用口内入路的更多（p < 0.001），这表明脓肿位置与临床表现时的年龄有关。还发现年龄较小的队列术前白细胞计数较高（20.7对17.5，p < 0.001），但术前暴发性脓毒症无显著差异。发现年龄较小的儿童手术前等待时间更长（1.4天对1.1天，p = 0.003）且住院时间延长（LOS）（4.3天对3.4天，p < 0.001）。发现年龄较小的队列手术时间较短（18.4分钟对21.5分钟，p = 0.003）。最后，发现年龄较小的队列术后机械通气的发生率和持续时间增加（分别为63次对41次，0.4天对0.1天，p < 0.001）。术后并发症（伤口感染、裂开、肺炎、再次插管以及再次手术/再入院）无差异。住院时间的线性回归显示主要影响因素是手术时间、术后通气天数以及从入院到手术的天数，R = 0.700。
2岁以下儿童住院时间更长，这可能部分归因于术后通气可能性更大以及手术干预延迟，尽管其手术入路相关的住院时间较短。他们并不比年龄较大的儿童更易发生并发症。认识到这些关键因素对于优化该患者群体的围手术期风险评估和手术规划具有重要意义。
