Miller Rebecca, Tumin Dmitry, McKee Christopher, Raman Vidya T, Tobias Joseph D, Cooper Jennifer N
Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.
Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio.
Laryngoscope Investig Otolaryngol. 2019 Jan 17;4(1):30-38. doi: 10.1002/lio2.243. eCollection 2019 Feb.
Accurate assessment of risk factors such as congenital heart disease (CHD) can aid in risk stratification of children presenting for surgery. Risk stratification is especially important in tonsillectomy ± adenoidectomy (T/A), a common pediatric procedure that is usually performed electively, but that has a high rate of adverse events. In this study, we examined the association of CHD with revisits after T/A.
We identified children who underwent T/A at hospitals and hospital-owned facilities during 2010 to 2014 using the State Inpatient Databases and State Ambulatory Surgery and Services Databases of Florida, Georgia, Iowa, New York, and Utah. We evaluated the association between CHD severity and the occurrence of an unplanned hospital readmission or ED visit within 30 days following discharge using multivariable logistic regression.
The analysis included 244,598 patients, of whom 858 had minor or major CHD. In multivariable analysis, CHD was not associated with an increased risk of 30-day revisits (minor OR = 1.1; 95% CI: 0.8, 1.5; = .65; major OR = 1.2; 95% CI: 0.9, 1.6; = .34). Other comorbidities, including chromosomal anomalies (OR = 1.4; 95% CI: 1.2, 1.6; < .001), congenital airway anomalies (OR = 1.3; 95% CI: 1.03, 1.7; = .03), and neuromuscular impairment (OR = 1.4; 95% CI: 1.2, 1.7; < .001) predicted an increased likelihood of revisits.
Neither minor nor major CHD was independently associated with an increased risk of 30-day revisits among children undergoing T/A. Other characteristics, particularly non-cardiac comorbidities, socioeconomic status, and geographic region may be of greater utility for predicting revisit risk following pediatric T/A.
2b.
准确评估先天性心脏病（CHD）等风险因素有助于对接受手术的儿童进行风险分层。风险分层在扁桃体切除术±腺样体切除术（T/A）中尤为重要，这是一种常见的儿科手术，通常为择期手术，但不良事件发生率较高。在本研究中，我们探讨了CHD与T/A术后再次就诊之间的关联。
我们利用佛罗里达州、佐治亚州、爱荷华州、纽约州和犹他州的州住院数据库以及州门诊手术和服务数据库，确定了2010年至2014年期间在医院及医院所属机构接受T/A手术的儿童。我们使用多变量逻辑回归评估CHD严重程度与出院后30天内计划外再次住院或急诊就诊发生率之间的关联。
分析纳入了244,598例患者，其中858例患有轻度或重度CHD。在多变量分析中，CHD与30天内再次就诊风险增加无关（轻度CHD：比值比[OR]=1.1；95%置信区间[CI]：0.8，1.5；P=.65；重度CHD：OR=1.2；95%CI：0.9，1.6；P=.34）。其他合并症，包括染色体异常（OR=1.4；95%CI：1.2，1.6；P<.001）、先天性气道异常（OR=1.3；95%CI：1.03，1.7；P=.03）和神经肌肉损伤（OR=1.4；95%CI：1.2，1.7；P<.001）预示再次就诊的可能性增加。
在接受T/A手术的儿童中，轻度或重度CHD均与30天内再次就诊风险增加无独立关联。其他特征，特别是非心脏合并症、社会经济地位和地理区域，可能对预测儿科T/A术后再次就诊风险更有用。
2b。
