Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina; Department of Pediatrics, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina.
Clin Gastroenterol Hepatol. 2019 Dec;17(13):2713-2721.e4. doi: 10.1016/j.cgh.2019.03.003. Epub 2019 Mar 7.
BACKGROUND & AIMS: Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the proportion of colectomies performed at high-volume centers. We then evaluated the association between hospital colectomy volume and complications.
We performed a cross-sectional analysis of pediatric patients (age, ≤18 y) hospitalized for UC using the Kids' Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications.
A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5-0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions.
Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (<5%) are performed at high-volume centers.
在高容量中心接受结肠切除术的溃疡性结肠炎（UC）成年患者的结果优于低容量中心的患者，且并发症更少。我们旨在评估小儿 UC 患者全腹部结肠切除术（TAC）的医院容量，并探讨高容量中心进行结肠切除术的比例随时间的变化趋势。然后，我们评估了医院结肠切除术量与并发症之间的关系。
我们使用 Kids' Inpatient Database（儿科住院患者的全国代表性数据库）对患有 UC 的儿科患者（年龄，≤18 岁）进行了一项横断面分析。我们从 1997 年至 2016 年通过程序代码（国际疾病分类，第 9 或第 10 版）识别出 UC 住院患者 TAC。我们使用改编自已发表算法的诊断代码来定义并发症。我们将高容量定义为每年进行 10 次或更多 TAC 的医院。我们使用多变量统计来评估医院量与住院并发症之间的关系。
共有 1453 例患有 UC 的儿童住院患者进行了 TAC（全国范围内有 2306 例结肠切除术）。共有 766 家医院进行了 1 次或更多次年度结肠切除术，但只有 36 家（4.7％）是高容量医院，占结肠切除术的 21％。随着时间的流逝，高容量医院进行的结肠切除术的比例下降。高容量中心的并发症绝对风险为 16％，而低容量中心为 22％（调整后的优势比，0.7；95％CI，0.5-0.9）。对于非紧急入院，每年 TAC 量对并发症风险的影响没有统计学意义。
在高容量中心接受结肠切除术的小儿 UC 患者的并发症更少。但是，只有不到 5％的小儿结肠切除术（<5％）在高容量中心进行。
