Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
Laryngoscope. 2022 Mar;132 Suppl 5:S1-S9. doi: 10.1002/lary.28927. Epub 2020 Aug 3.
OBJECTIVES/HYPOTHESIS: The role for endoscopic management in children with subglottic stenosis (SGS) has grown, but there are no data on resource utilization or the impact on surgical training in pediatric otolaryngology. This study hypothesizes that this shift has increased resource utilization and has impacted surgical training by shifting the focus toward more endoscopic techniques.
Retrospective database review.
The Kids' Inpatient Database for 2003, 2006, 2009, and 2012 was queried for admissions with the diagnosis of SGS. Surgical caseload was studied using the Accreditation Council for Graduate Medical Education Accreditation data system for 2010 to 2017.
Admissions with SGS remained constant between 2003 and 2012. Hospital charges per admission did not change between 2003 and 2009 but increased in 2012. Tracheostomy decreased from 10.5% of admissions in 2003 to 6.8% in 2012. The percentage requiring repair of the larynx did not change; other operations on the larynx increased from 4.5% in 2003 to 11.6% in 2012. The median number of laryngoplasties performed per trainee decreased from 14 to nine between 2010 and 2017, whereas the number of laryngoscopy with intervention procedures increased from 34 to 56.
The evolution of SGS management appears to have led to a decrease in tracheostomy and an increase in certain procedures that may include endoscopic procedures. Recently, there has been a shift in airway surgical training, with trainees logging less open laryngotracheoplasty and more interventional laryngoscopy. Although these trends cannot be directly linked, the changes in trainee surgical experience may be justified by the decrease in larger open procedures and associated resource utilization.
2c Laryngoscope, 132:S1-S9, 2022.
目的/假设：内镜治疗在儿童声门下狭窄（SGS）中的作用不断增加，但目前尚无资源利用或对儿科耳鼻喉科手术培训影响的数据。本研究假设这种转变增加了资源利用，并通过将重点转移到更多的内镜技术上来影响手术培训。
回顾性数据库研究。
2003 年、2006 年、2009 年和 2012 年，通过儿童住院数据库（Kids' Inpatient Database）检索 SGS 诊断的住院患者。2010 年至 2017 年，使用研究生医学教育认证委员会（Accreditation Council for Graduate Medical Education）认证数据系统研究手术工作量。
2003 年至 2012 年，SGS 患者的住院人数保持不变。2003 年至 2009 年，每次住院的医院费用没有变化，但 2012 年有所增加。气管切开术从 2003 年的 10.5%降至 2012 年的 6.8%。需要修复喉的比例没有变化；2003 年其他喉部手术为 4.5%，2012 年增加到 11.6%。每位受训者进行的喉成形术中位数从 2010 年至 2017 年从 14 次减少到 9 次，而进行干预性喉镜检查的次数从 34 次增加到 56 次。
SGS 管理方法的演变似乎导致气管切开术减少，某些可能包括内镜治疗的程序增加。最近，气道手术培训发生了转变，受训者记录的开放性喉气管成形术减少，介入性喉镜检查增加。尽管这些趋势不能直接联系起来，但由于较大的开放性手术减少和相关资源利用，受训者手术经验的变化可能是合理的。
2c 喉镜，132：S1-S9，2022 年。
