小儿矫形外科手术在独立的日间手术中心是否安全？3780 例回顾。

Can Pediatric Orthopaedic Surgery be Done Safely in a Freestanding Ambulatory Surgery Center? Review of 3780 Cases.

机构信息

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Le Bonheur Children's.

University of Tennessee Health Science Center College of Medicine.

出版信息

J Pediatr Orthop. 2021 Jan;41(1):e85-e89. doi: 10.1097/BPO.0000000000001670.

DOI:10.1097/BPO.0000000000001670

PMID:32852367

Abstract

BACKGROUND

The purpose of this study was to determine the intraoperative and 30-day postoperative complication rates in a large consecutive cohort of pediatric patients who had orthopaedic surgery at a freestanding ambulatory surgery center (ASC). The authors also wanted to identify the rates of same-day, urgent hospital transfers, and 30-day hospital admissions. The authors hypothesized that pediatric orthopaedic procedures at a freestanding ASC can be done safely with a low rate of complications.

METHODS

A retrospective review identified patients aged 17 years or younger who had surgery at a freestanding ASC over a 9-year period. Adverse outcomes were divided into intraoperative complications, postoperative complications, need for the secondary procedure, unexpected hospital admission on the same day of the procedure, and unexpected hospital admission within 30 days of the index procedure. Complications were graded as grade 1, the complication could be treated without additional surgery or hospitalization; grade 2, the complication resulted in an unplanned return to the operating room (OR) or hospital admission; or grade 3, the complication resulted in an unplanned return to the OR or hospitalization with a change in the overall treatment plan.

RESULTS

Adequate follow-up was available for 3780 (86.1%) surgical procedures. Overall, there were 9 (0.24%) intraoperative complications, 2 (0.08%) urgent hospital transfers, 114 (3%) complications, and 16 (0.42%) readmissions. Seven of the 9 intraoperative complications resolved before leaving the OR, and 2 required return to the OR.Neither complications nor hospitalizations correlated with age, race, gender, or length or type of surgery. There was no correlation between the presence of medical comorbidities, body mass index, or American Society of Anesthesiologists score and complication or hospitalization.

CONCLUSIONS

Pediatric orthopaedic surgical procedures can be performed safely in an ASC because of multiple factors that include dedicated surgical teams, single-purpose ORs, and strict preoperative screening criteria. The rates of an emergency hospital transfer, surgical complications, and 30-day readmission, even by stringent criteria, are lower than those reported for outpatient procedures performed in the hospital setting.

LEVEL OF EVIDENCE

Level IV-case series.

摘要

背景

本研究的目的是确定在一家独立的日间手术中心（ASC）接受骨科手术的大量连续儿科患者的术中及术后 30 天并发症发生率。作者还想确定当天、紧急转院和 30 天住院的比例。作者假设在独立 ASC 进行的小儿矫形手术可以安全进行，并发症发生率低。

方法

回顾性分析了 9 年内在 ASC 接受手术的年龄在 17 岁及以下的患者。不良结局分为术中并发症、术后并发症、需要二次手术、手术当天意外住院和指数手术后 30 天内意外住院。并发症分为 1 级，并发症无需进一步手术或住院治疗；2 级，并发症导致计划外返回手术室（OR）或住院；3 级，并发症导致计划外返回 OR 或住院，并改变整体治疗计划。

结果

3780 例（86.1%）手术获得充分随访。总的来说，有 9 例（0.24%）术中并发症，2 例（0.08%）紧急转院，114 例（3%）并发症，16 例（0.42%）再入院。9 例术中并发症中，有 7 例在离开手术室前得到解决，有 2 例需要返回手术室。并发症和住院均与年龄、种族、性别、手术时长或类型无关。合并症、体重指数或美国麻醉医师协会评分与并发症或住院无相关性。