Hu Allison C, Bertrand Anthony A, Dang Brian N, Chan Candace H, Lee Justine C
From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
Ann Plast Surg. 2020 Nov;85(5):574-583. doi: 10.1097/SAP.0000000000002291.
Birth defects affect 3% of all babies born in the United States each year. Unlike reconstruction for many acquired deformities, one hallmark of reconstruction for complex congenital conditions is the requirement of multiple surgeries, procedures, and therapies from birth to maturity. These interventions often result in significant medical burden on children during development with potential long-term psychosocial consequences. The aim of this study was therefore to better define the psychosocial impact of repetitive operations on the pediatric patient.
A scoping review was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines. We searched the PubMed, Cochrane Library, Science Direct, and Web of Science databases using key words "number of surgeries," "psychosocial," "pediatric," and related terms. Primary articles published in English describing psychosocial outcomes in pediatric patients who underwent more than one procedure or surgery were included (n = 25). The Newcastle-Ottawa Scale was used to assess the quality of each study.
We included 25 articles published between 1995 and 2019, which included 6520 patients. The most common diagnosis across all studies was congenital heart disease (CHD) (n = 4169, 63.9%), followed by cleft lip and palate (n = 1196, 18.3%). The average number of operations and procedures was 3.4 (range = 1-18) and 32.1 (range = 6-89), respectively. The association between repetitive surgeries and poorer psychosocial outcomes was demonstrated in children with early-onset scoliosis, CHD, hydrocephalus, bladder exstrophy, posterior urethral rupture, anorectal anomalies, and conditions requiring numerous nonsurgical procedures. There were also a few CHD, cleft lip and/or palate, and hydrocephalus studies that did not find a significant correlation.
The studies here suggest that certain pediatric patient populations are at risk for impaired psychosocial functioning as a result of repetitive procedures. However, it is important to differentiate whether the association with poorer psychosocial outcomes is from the number of surgical procedures or whether the number if just a surrogate for increased disease complexity. Standardized psychosocial outcomes measures and future prospective, long-term, randomized clinical trials are also warranted.
出生缺陷影响着美国每年出生的所有婴儿的3%。与许多后天畸形的重建不同，复杂先天性疾病重建的一个标志是从出生到成年需要多次手术、操作和治疗。这些干预措施往往会给儿童发育带来重大医疗负担，并可能产生长期的心理社会后果。因此，本研究的目的是更好地界定重复性手术对儿科患者的心理社会影响。
根据系统评价和Meta分析扩展的首选报告项目（PRISMA-ScR）指南进行了一项范围综述。我们使用关键词“手术次数”“心理社会”“儿科”及相关术语检索了PubMed、Cochrane图书馆、Science Direct和Web of Science数据库。纳入以英文发表的描述接受过不止一次手术或操作的儿科患者心理社会结局的原始文章（n = 25）。使用纽卡斯尔-渥太华量表评估每项研究的质量。
我们纳入了1995年至2019年间发表的25篇文章，其中包括6520名患者。所有研究中最常见的诊断是先天性心脏病（CHD）（n = 4169，63.9%），其次是唇腭裂（n = 1196，18.3%）。手术和操作的平均次数分别为3.4次（范围 = 1 - 18次）和32.1次（范围 = 6 - 89次）。在早发性脊柱侧弯、先天性心脏病、脑积水、膀胱外翻、后尿道破裂、肛门直肠畸形以及需要进行大量非手术操作的疾病患儿中，重复性手术与较差的心理社会结局之间存在关联。也有一些关于先天性心脏病、唇裂和/或腭裂以及脑积水的研究未发现显著相关性。
此处的研究表明，某些儿科患者群体因重复性操作而存在心理社会功能受损的风险。然而，区分心理社会结局较差与手术操作次数的关联是由于手术次数本身，还是手术次数只是疾病复杂性增加的一个替代指标，这一点很重要。还需要标准化的心理社会结局测量方法以及未来的前瞻性、长期、随机临床试验。
