Penn State Hershey Medical Center, Department of Otolaryngology - Head and Neck Surgery, USA.
Penn State Hershey College of Medicine, USA.
Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110402. doi: 10.1016/j.ijporl.2020.110402. Epub 2020 Sep 29.
The risk of expansile hematoma and airway compromise following neck surgery have been used to validate overnight observation. We investigated the outcomes of pediatric patients undergoing a removal of second branchial cleft anomalies (BCA) via either same day surgery or overnight observation.
A retrospective review of patients undergoing second BCA removal between January 1, 2008 to January 1, 2019 was performed. 40 cases were identified for review. Bivariate analyses were performed to determine predictive factors for overnight admission as well as associations between overnight observation and adverse outcomes (hematoma, seroma, airway compromise, infection). Factors evaluated for analysis included ASA class, surgeon type, history of pre-operative infection, recurrent case, operation >90 min, pharyngeal violation, intraoperative cyst rupture, cyst size, and drain placement.
There were no life-threatening adverse events. Same day discharge was not associated with adverse events (p = 0.24). Overnight observation was associated with a history of preoperative infection (p = 0.003), cyst > 3.0 cm (p = 0.046), operative time > 90 min (p < 0.001), and drain placement (p = 0.001). There was no association between other investigated variables and adverse events or overnight stay.
Same day discharge following second branchial cleft anomalies appears safe and feasible. Further study is needed to determine the safety profile of same day discharge and etiologies of practice patterns of overnight observation.
颈部手术后出现扩张性血肿和气道阻塞的风险已被用于验证过夜观察的必要性。我们调查了在同一天手术或过夜观察下接受第二鳃裂畸形（BCA）切除的儿科患者的结局。
对 2008 年 1 月 1 日至 2019 年 1 月 1 日期间接受第二鳃裂畸形切除的患者进行了回顾性研究。共确定了 40 例病例进行回顾分析。采用双变量分析来确定需要过夜住院的预测因素，以及过夜观察与不良结局（血肿、血清肿、气道阻塞、感染）之间的关系。评估的分析因素包括 ASA 分级、手术医生类型、术前感染史、复发性病例、手术时间>90 分钟、咽壁侵犯、术中囊肿破裂、囊肿大小和引流管放置。
无危及生命的不良事件。当天出院与不良事件无关（p=0.24）。过夜观察与术前感染史（p=0.003）、囊肿>3.0cm（p=0.046）、手术时间>90 分钟（p<0.001）和引流管放置（p=0.001）有关。其他研究变量与不良事件或过夜观察之间无关联。
第二鳃裂畸形切除后当天出院是安全可行的。需要进一步研究来确定当天出院的安全性和过夜观察实践模式的病因。
