Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
J Surg Res. 2019 Aug;240:182-190. doi: 10.1016/j.jss.2019.03.005. Epub 2019 Apr 4.
Three large national data sets are commonly used to assess operative outcomes in pediatric surgery; National Surgical Quality Improvement Program Pediatric (NSQIP-P), Pediatric Health Information System (PHIS), and Kids' Inpatient Data set (KID). Hepatectomy and nephrectomy are rare pediatric surgical procedures, which may benefit from large administrative data sets for the assessment of short-term complications.
A retrospective review of NSQIP-P (2012-2015), KID (2012), and PHIS (2012-2015) was performed for hepatectomy or nephrectomy cases for children aged 0 to 18 y. Thirty-day perioperative outcomes were collected, analyzed, and compared across data sets and surgical cohorts.
Rates of surgical site infection, wound dehiscence, central line infection, sepsis, and venous thromboembolism were similar across NSQIP-P, PHIS, and KID in both cohorts. Rates of pneumonia and renal insufficiency were higher in PHIS and KID versus NSQIP-P in both cohorts. Blood transfusions in NSQIP-P were higher than PHIS and KID in the hepatectomy group (50.9% versus 43.0% versus 32.4%, P < 0.001), but similar across data sets in the nephrectomy cohorts (12.0% versus 14.0% versus 13.0%, P = 0.15). PHIS reported higher readmission rates than NSQIP-P for both the hepatectomy (56.5% versus 17.9%, P < 0.001) and nephrectomy (32.6% versus 7.6%,P < 0.001) cohorts. Thirty-day mortality rates were similar between NSQIP-P and PHIS, but higher in KID as compared with NSQIP-P for hepatectomy (6.4% versus 0.4%, P < 0.001) and nephrectomy (2.0% versus 0.3%, P < 0.001) cases.
Administrative data sets provide large sample sizes for the study of low-volume procedures in children, but there are significant variations in the reported rates of perioperative outcomes between NSQIP-P, PHIS, and KID. Therefore, surgical outcomes should be interpreted within the context of the strengths and limitations of each data set.
有三个大型国家数据集常用于评估小儿外科手术的手术结果，分别是国家外科质量改进计划儿科（NSQIP-P）、儿科健康信息系统（PHIS）和住院患儿数据（KID）。肝切除术和肾切除术是罕见的小儿外科手术，可能受益于大型行政数据集来评估短期并发症。
对 2012 年至 2015 年的 NSQIP-P、2012 年的 KID 和 2012 年至 2015 年的 PHIS 中年龄在 0 至 18 岁的肝切除术或肾切除术病例进行回顾性分析。收集并分析了 30 天围手术期的结果，并在数据集和手术队列之间进行了比较。
在两组中，NSQIP-P、PHIS 和 KID 的手术部位感染、伤口裂开、中心静脉感染、败血症和静脉血栓栓塞的发生率相似。两组中，PHIS 和 KID 的肺炎和肾功能不全的发生率均高于 NSQIP-P。在肝切除术组中，NSQIP-P 的输血率高于 PHIS 和 KID（50.9%比 43.0%比 32.4%，P<0.001），但在肾切除术组中，三个数据集的输血率相似（12.0%比 14.0%比 13.0%，P=0.15）。PHIS 报告的肝切除术（56.5%比 17.9%，P<0.001）和肾切除术（32.6%比 7.6%，P<0.001）两组的再入院率均高于 NSQIP-P。NSQIP-P 和 PHIS 的 30 天死亡率相似，但 KID 的肝切除术（6.4%比 0.4%，P<0.001）和肾切除术（2.0%比 0.3%，P<0.001）的死亡率均高于 NSQIP-P。
行政数据集为研究儿童低容量手术提供了大量样本，但 NSQIP-P、PHIS 和 KID 之间报告的围手术期结果存在显著差异。因此，应根据每个数据集的优势和局限性来解释手术结果。
