Tom Cynthia M, Won Roy P, Friedlander Scott, Sakai-Bizmark Rie, de Virgilio Christian, Lee Steven L
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
Am Surg. 2018 Oct 1;84(10):1547-1550.
Variations in the management of adolescents at children's hospitals (CHs) and nonchildren's hospitals (NCHs) have been well described in the trauma literature. However, the effects of CH designation on outcomes after common general surgical procedures have not been investigated. The purpose of this study was to compare the outcomes and costs of adolescent cholecystectomies performed at CHs and NCHs. Within the California State Inpatient Database (2005-2011), we identified 8117 cholecystectomy patients aged 13 to 18 years at CHs and NCHs. Outcomes (laparoscopy, intraoperative cholangiogram, length of stay (LOS), and complications) and costs were analyzed. CHs cared for younger patients, more uninsured patients, and more black patients. NCHs were associated with higher laparoscopy use (95.7% 88.3%, < 0.01), higher intraoperative cholangiogram rates (28.8% 11.9%, < 0.001), shorter LOS (3.2 5.0 days, < 0.01), and lower costs by $5797 per patient ($11,219 $17,016, < 0.01). Although there was no significant difference in overall complication rates, CHs had higher rates of infectious complications (2.0% 1.0%, = 0.004). Adolescent cholecystectomies are safely performed at NCHs while achieving increased laparoscopy use, shorter LOS, and lower costs compared with CHs.
儿童医院（CHs）和非儿童医院（NCHs）对青少年的管理差异在创伤文献中已有详尽描述。然而，CH指定对常见普通外科手术后结局的影响尚未得到研究。本研究的目的是比较在CHs和NCHs进行青少年胆囊切除术的结局和成本。在加利福尼亚州住院患者数据库（2005 - 2011年）中，我们识别出8117例在CHs和NCHs接受胆囊切除术的13至18岁患者。分析了结局（腹腔镜检查、术中胆管造影、住院时间（LOS）和并发症）及成本。CHs照料的患者更年轻、 uninsured患者更多、黑人患者更多。NCHs与更高的腹腔镜使用率（95.7%对88.3%，P<0.01）、更高的术中胆管造影率（28.8%对11.9%，P<0.001）、更短的LOS（3.2天对5.0天，P<0.01）以及每位患者成本低5797美元（11219美元对17016美元，P<0.01）相关。尽管总体并发症发生率无显著差异，但CHs的感染性并发症发生率更高（2.0%对1.0%，P = 0.004）。与CHs相比，青少年胆囊切除术在NCHs安全实施，同时腹腔镜使用率增加、LOS更短且成本更低。
