Munawar Suqrat, Marston Alexander P, Patel Terral, Nguyen Shaun A, White David R
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Ann Otol Rhinol Laryngol. 2020 Jun;129(6):556-564. doi: 10.1177/0003489419900201. Epub 2020 Jan 10.
Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery.
Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids' Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal-Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square.
Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all < .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, < .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, > .05).
The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.
分析接受多级睡眠手术的综合征型和非综合征型儿童在住院时间、费用、出院处置及人口统计学特征方面的差异。
从医疗保健研究与质量局医疗成本和利用项目的1997年至2012年版儿童住院数据库中筛选出接受过睡眠手术的睡眠呼吸障碍或阻塞性睡眠呼吸暂停儿童。然后将儿童分为综合征型或非综合征型，并按睡眠手术级别（扁桃体切除术和腺样体切除术、扁桃体切除术和腺样体切除术加其他部位手术、其他部位手术）进行分层。住院时间和费用采用Kruskal-Wallis单因素方差分析报告，出院处置采用二项逻辑回归分析，人口统计学特征采用卡方检验。
与非综合征型儿童相比，综合征型儿童更有可能接受除扁桃体切除术和腺样体切除术之外的手术，且住院时间更长、总费用更高、出院处置非常规（均P＜0.001）。接受扁桃体切除术和腺样体切除术加其他部位手术的综合征型儿童比接受扁桃体切除术和腺样体切除术的综合征型儿童住院时间更长（6.00天对3.63天，P＜0.001）。然而，在非综合征型儿童中未发现类似的住院时间统计学显著差异（2.01天对2.87天，P＞0.05）。
在对综合征型儿童进行睡眠手术之前，需要仔细权衡潜在的风险/益处。与非综合征型儿童相比，他们的住院时间更长、费用更高、出院处置非常规。在考虑从扁桃体切除术和腺样体切除术过渡到扁桃体切除术和腺样体切除术加其他部位手术时尤其如此，因为综合征型儿童住院时间更长而非综合征型儿童则不然。
