Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
J Pediatr Surg. 2019 Sep;54(9):1832-1837. doi: 10.1016/j.jpedsurg.2018.11.013. Epub 2018 Dec 13.
This paper intends to evaluate the association between Down Syndrome (DS) and postoperative medical and surgical complications and inpatient postoperative mortality in pediatric patients undergoing intestinal operations.
The 2012 Kids' Inpatient Database was queried to compare short-term postoperative medical and surgical complications and in-patient mortality among patients with DS undergoing intestinal operations to a cohort without DS using inverse probability weighting. Subset analysis was performed for patients undergoing intestinal operations exclusive of gastrostomy placement. Adverse treatment effects were calculated for the outcomes of interest.
Of 17,026 pediatric patients undergoing intestinal operations, 444 had DS. In unadjusted analysis, medical complications (urinary tract infection, deep venous thrombosis, sepsis, pneumonia) occurred in 7.9% of patients with DS, compared to 14.1% of those without (p < 0.001). Surgical complications (wound disruption, hemorrhage, superficial or deep wound infection) occurred in 3.5% of patients with DS, compared to 4.6% of those without (p = 0.34), and in-patient mortality occurred in 0.3% of patients with DS, compared to 2.7% of those without (p = 0.009). Adverse treatment effects (ATE) calculated after inverse probability weighting demonstrated no difference for medical or surgical complications but a significantly decreased mortality with DS.
Contrary to common perception and data extrapolated from the adult literature, pediatric patients with DS have neither higher medical nor surgical complication rates after intestinal operations. Similar to patients undergoing congenital heart surgery, pediatric patients with DS have a lower postoperative inpatient mortality after these general operations compared to those without DS. Mechanisms influencing risks in DS patient remain unknown.
Level III, retrospective comparative study.
本文旨在评估唐氏综合征（Down Syndrome，DS）与儿科患者行肠手术术后医疗和手术并发症及住院期间死亡率之间的关系。
通过查询 2012 年儿童住院数据库，采用逆概率加权法比较了行肠手术的 DS 患儿与非 DS 患儿短期术后医疗和手术并发症及住院期间死亡率。对排除胃造口术的肠手术患者进行了亚组分析。计算了感兴趣结局的不良治疗效果。
在 17026 例行肠手术的儿科患者中，有 444 例患有 DS。未经调整分析，DS 患儿的医疗并发症（尿路感染、深静脉血栓形成、败血症、肺炎）发生率为 7.9%，而非 DS 患儿为 14.1%（p<0.001）。DS 患儿的手术并发症（伤口破裂、出血、浅表或深部伤口感染）发生率为 3.5%，而非 DS 患儿为 4.6%（p=0.34），DS 患儿的住院期间死亡率为 0.3%，而非 DS 患儿为 2.7%（p=0.009）。经逆概率加权后计算的不良治疗效果（ATE）表明，DS 患儿的医疗或手术并发症发生率无差异，但死亡率显著降低。
与普遍认知和从成人文献推断的数据相反，行肠手术的儿科 DS 患儿的医疗和手术并发症发生率均不高。与行先天性心脏手术的患儿类似，这些普通手术术后 DS 患儿的住院期间死亡率低于非 DS 患儿。影响 DS 患者风险的机制尚不清楚。
III 级，回顾性比较研究。
