Complex Care Service, Division of General Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Dev Med Child Neurol. 2021 Feb;63(2):204-210. doi: 10.1111/dmcn.14712. Epub 2020 Nov 9.
To assess how co-occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs).
This was a retrospective analysis of 4058 children age 4 years or older with neurological CCCs who underwent hip reconstructive surgery between 1st January 2015 and 31st December 2018 in 49 children's hospitals. The presence of co-occurring chronic conditions was assessed using the Agency for Healthcare Research Chronic Condition Indicator system. Multivariable, hierarchical regression was used to assess the relationship between co-existing conditions and postoperative hospital length of stay (LOS), cost, and 30-day readmission rate.
The most common co-occurring conditions were digestive (60.1%) and respiratory (37.9%). As the number of co-existing conditions increased from one to four or more, median LOS increased 67% (3d [interquartile range {IQR} 2-4d] to 5d [IQR 3-8d]); median hospital cost increased 41% ($20 248 [IQR $14 921-$27 842] to $28 692 [IQR $19 236-$45 887]); and readmission rates increased 250% (5.5-13.9%), p<0.001 for all. Of all specific co-existing chronic conditions, malnutrition was associated with the greatest increase in postoperative hospital resource use.
Co-occurring conditions, and malnutrition in particular, are a significant risk factor for prolonged, in-hospital recovery after hip reconstruction surgery in children with a neurological CCC. Further investigation is necessary to assess how improved preoperative optimization of multiple co-occurring conditions may improve postoperative outcomes and resource utilization.
Children with neurological complex chronic conditions (CCCs) often develop hip disorders which require hip reconstruction surgery. Co-occurring conditions are common in children with neuromuscular CCCs. Having four or more chronic conditions was associated with a longer length of stay, increased costs, and higher odds of readmission. Malnutrition was a significant risk factor for prolonged hospitalization after hip reconstruction surgery.
评估共存疾病如何影响患有神经发育障碍的儿童髋关节重建手术后的恢复。
这是一项回顾性分析，纳入了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在 49 家儿童医院接受髋关节重建手术的 4058 名年龄在 4 岁或以上的神经发育障碍儿童。使用医疗机构医疗保健研究慢性状况指标系统评估共存慢性疾病的存在。采用多变量、分层回归分析评估共存疾病与术后住院时间（LOS）、费用和 30 天再入院率之间的关系。
最常见的共存疾病是消化系统（60.1%）和呼吸系统疾病（37.9%）。随着共存疾病数量从一种增加到四种或更多种，中位 LOS 增加了 67%（3d [四分位距 {IQR} 2-4d] 至 5d [IQR 3-8d]）；中位住院费用增加了 41%（$20248 [IQR $14921-$27842] 至 $28692 [IQR $19236-$45887]）；再入院率增加了 250%（5.5-13.9%），p<0.001。在所有共存的慢性疾病中，营养不良与术后住院资源利用增加的关系最大。
共存疾病，特别是营养不良，是神经发育障碍儿童髋关节重建手术后住院时间延长的一个重要危险因素。需要进一步研究以评估如何优化多种共存疾病的术前状况，从而改善术后结局和资源利用。
患有神经发育障碍的儿童常发生髋关节疾病，需要进行髋关节重建手术。神经发育障碍儿童常伴有共存疾病。患有四种或更多种慢性疾病与住院时间延长、费用增加和再入院率升高相关。营养不良是髋关节重建手术后住院时间延长的一个重要危险因素。
