Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA.
J Pediatr Surg. 2021 May;56(5):868-874. doi: 10.1016/j.jpedsurg.2020.07.004. Epub 2020 Jul 12.
Most pediatric cholecystectomies are performed by adult general surgeons, but it is unclear whether outcomes differ by surgeon pediatric subspecialization, hospital procedure volume, or surgeon procedure volume. We aimed to determine whether higher hospital or surgeon laparoscopic cholecystectomy (LC) volume or surgeon pediatric subspecialization is associated with better outcomes after LC in children.
We performed a retrospective cohort study using statewide hospital discharge databases from the states of Florida, Georgia, and Iowa. We included children aged 4-18 years who underwent inpatient or outpatient LC for acute or chronic gallbladder disease in January 2010-August 2015. Propensity score weighting was used to estimate relationships between operative volumes or surgeon pediatric subspecialization and rates of readmission or emergency department (ED) visit within 30 days.
A total of 5391 children were included (mean age 15.9 years, 81.6% female). Children operated on by surgeons with high LC volumes in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.8% vs. 13.7%, p = 0.04). Additionally, children operated on by adult general surgeons in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.9% vs. 13.8%, p = 0.03).
Children are less likely to be readmitted to the hospital or present to the ED after laparoscopic cholecystectomy if they receive their care from adult general surgeons at hospitals that frequently perform this procedure in both adults and children.
III.
大多数小儿胆囊切除术由成人普外科医生进行，但目前尚不清楚手术医生是否为小儿外科亚专科医生、医院手术量或医生手术量是否会影响手术结果。我们旨在确定较高的医院或外科医生腹腔镜胆囊切除术（LC）量或外科医生小儿外科亚专科是否与儿童 LC 后更好的结果相关。
我们使用来自佛罗里达州、佐治亚州和爱荷华州的全州医院出院数据库进行了回顾性队列研究。我们纳入了年龄在 4-18 岁之间，在 2010 年 1 月至 2015 年 8 月期间因急性或慢性胆囊疾病行住院或门诊 LC 的儿童。采用倾向评分加权法估计手术量或外科医生小儿外科亚专科与 30 天内再入院或急诊就诊率之间的关系。
共纳入 5391 例儿童（平均年龄 15.9 岁，81.6%为女性）。在手术量大的医院由手术量大的外科医生进行 LC 的儿童，30 天内再入院或急诊就诊的比例较低（10.8%比 13.7%，p=0.04）。此外，在手术量大的医院由成人普外科医生进行 LC 的儿童，30 天内再入院或急诊就诊的比例也较低（10.9%比 13.8%，p=0.03）。
如果儿童在成人普外科医生所在的医院接受 LC 治疗，该医院在成人和儿童中经常进行该手术，则其再入院或急诊就诊的可能性较小。
III 级。
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