Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2021 Apr;131(4):907-910. doi: 10.1002/lary.28895. Epub 2020 Jul 18.
Gastroesophageal reflux (GER) has been identified as a risk factor for complications following pediatric tonsillectomy. The primary objective of this study was to examine outcomes after tonsillectomy among children with GER using a nationwide database. Secondary objectives included analyzing duration of hospitalization and total charges after admission.
A cross-sectional review of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) from 2012 and 2016.
A total of 21,232 children had a tonsillectomy with or without adenoidectomy, with 1683 (7.9%) diagnosed with GER. Average age for patients with reflux was 4.4 years and for those without was 5.6 years (P < .001). The rate of primary hemorrhage was not statistically different between groups (P = .87). Patients with reflux were more likely to have respiratory complications (P = .03), aspiration pneumonitis (P < .001), and hypoxemia (P < .001) during their hospital course. Noninvasive ventilation and reintubation also occurred more frequently in this population (P < .001). Children with reflux had a longer duration of postoperative admission (3.8 vs. 2.3 days, P < .001) and higher total hospital charges ($47,129 vs. $27,584, P < .001). Multivariable regression analysis determined that reflux remained a statistically significant indicator of aspiration pneumonitis, hypoxemia, invasive and non-invasive ventilation, as well as length of admission.
Children with GER were significantly more likely to experience inpatient complications following tonsillectomy. Further, length of admission was higher compared to children without reflux. These results suggest that children with GER experience poorer outcomes after tonsillectomy and highlight the role for appropriate preoperative counseling and planning in this patient population. Laryngoscope, 131:907-910, 2021.
胃食管反流（GER）已被确定为小儿扁桃体切除术并发症的危险因素。本研究的主要目的是使用全国性数据库检查 GER 儿童扁桃体切除术后的结果。次要目标包括分析住院时间和入院后的总费用。
对 2012 年和 2016 年医疗保健成本和利用项目（HCUP）儿科住院患者数据库（KID）进行横断面回顾。
共有 21232 例儿童行扁桃体切除术，伴或不伴腺样体切除术，其中 1683 例（7.9%）诊断为 GER。反流患儿的平均年龄为 4.4 岁，无反流患儿的平均年龄为 5.6 岁（P<.001）。两组间原发性出血率无统计学差异（P=.87）。反流组更易发生呼吸系统并发症（P=.03）、吸入性肺炎（P<.001）和低氧血症（P<.001）。该人群中非侵入性通气和再插管也更为常见（P<.001）。反流患儿术后住院时间较长（3.8 天 vs. 2.3 天，P<.001），总住院费用较高（47129 美元 vs. 27584 美元，P<.001）。多变量回归分析确定，反流仍然是吸入性肺炎、低氧血症、有创和无创通气以及住院时间的统计学显著指标。
GER 儿童扁桃体切除术后更易发生住院并发症。此外，与无反流儿童相比，GER 儿童的住院时间更长。这些结果表明，GER 儿童扁桃体切除术后的结局较差，强调了在该患者群体中进行适当的术前咨询和计划的重要性。喉镜，131：907-910，2021。
