Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA, USA.
J Pediatr Surg. 2020 Jul;55(7):1324-1329. doi: 10.1016/j.jpedsurg.2019.06.005. Epub 2019 Jun 21.
To examine hospital-level variation in the timing of asymptomatic umbilical hernia repair in children.
Retrospective analysis of children undergoing umbilical hernia repair at 38 children's hospitals using the Pediatric Health Information System database (01/2013-12/2017). Early repair was defined as surgery performed at 3 years of age or younger. Repairs were categorized as emergent/urgent if associated with diagnostic or procedural codes indicating obstruction or strangulation, or if they occurred within 2 weeks of an emergency department encounter. Multivariable regression was used to calculate hospital-level observed-to-expected (O/E) ratios for early repair adjusting for emergent/urgent repair and patient characteristics.
23,144 children were included, of which 30% underwent early repair (hospital range: 6.9%-54.3%, p ≪ 0.001). Overall, 3.8% of all repairs were emergent/urgent, and higher rates of early repair did not correlate with higher rates of emergent/urgent repair across hospitals (r = -0.10). Following adjustment, hospital-level O/E ratios for early repair varied 8.9-fold (0.19-1.70, p ≪ 0.001).
Timing of asymptomatic umbilical hernia repair varies widely across children's hospitals, and the magnitude of this variation cannot be explained by differences in patient characteristics or the acuity of repair. Many children may be undergoing repair of hernias that may spontaneously close with further observation.
Level III (retrospective comparative study).
研究儿童无症状脐疝修复的时机在医院间的差异。
利用儿童健康信息系统数据库（2013 年 1 月至 2017 年 12 月）对 38 家儿童医院进行的儿童脐疝修复回顾性分析。早期修复定义为 3 岁或以下进行的手术。如果与指示梗阻或绞窄的诊断或程序代码相关，或者如果它们发生在急诊科就诊后 2 周内，则将修复归类为紧急/紧急情况。使用多变量回归计算调整紧急/紧急修复和患者特征后，医院层面观察到的预期（O/E）早期修复比值。
共纳入 23144 名儿童，其中 30%（医院范围：6.9%-54.3%，p≪0.001）进行了早期修复。总体而言，所有修复的 3.8%为紧急/紧急情况，早期修复率较高与医院间紧急/紧急修复率较高之间没有相关性（r= -0.10）。调整后，早期修复的医院层面 O/E 比值差异为 8.9 倍（0.19-1.70，p≪0.001）。
无症状脐疝修复的时间在儿童医院之间差异很大，这种差异的幅度不能用患者特征或修复的紧迫性的差异来解释。许多儿童可能正在接受可能会随着进一步观察而自行闭合的疝的修复。
III 级（回顾性比较研究）。
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