有无 Robin 序列的腭裂患者的腭裂修复时机。
Timing of Cleft Palate Repair in Patients With and Without Robin Sequence.
机构信息
Division of Plastic and Reconstructive Surgery.
Division of Infectious Diseases, Department of Medicine.
出版信息
J Craniofac Surg. 2021 May 1;32(3):931-935. doi: 10.1097/SCS.0000000000007311.
BACKGROUND
This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims.
METHODS
Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10-14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models.
RESULTS
A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09-0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10-14 months (adjusted HR 0.40, 95%CI 0.31-0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57-0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty.
CONCLUSIONS
In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.
背景
本队列研究旨在利用商业医疗保险索赔的全国性数据库，评估修复年龄如何影响非综合征型伴或不伴 Robin 序列患者的结局。
方法
根据 ICD-9-CM 和 CPT 手术代码，在 IBM MarketScan 商业数据库中确定 4 岁以下行腭裂修补术的儿童。他们分为 Robin 和非 Robin 腭裂组，并根据初次腭裂修复的时间进一步分为 Robin 序列组：年龄≤10 个月或＞10 个月；非 Robin 腭裂组：年龄≤10 个月、＞10-14 个月和＞14 个月。采用 Cox 比例风险模型评估每个组内腭裂修复的时间。
结果
共纳入 261 例 Robin 序列患者和 3046 例非 Robin 腭裂患者。在 Robin 序列患者中，与早期修复相比，晚期修复与二次手术风险降低相关（风险比（HR）0.19，95%置信区间 0.09-0.39，P<0.001）。在非 Robin 腭裂患者中，与早期修复相比，修复时间在 10-14 个月（调整后的 HR 0.40，95%置信区间 0.31-0.52，P<0.001）和＞14 个月（调整后的 HR 0.71，95%置信区间 0.57-0.88，P=0.002）时，二次手术风险降低。调整修复时间后，在腭裂修补术前 30 天内诊断为生长发育迟缓或贫血的非 Robin 腭裂患者，二次手术的风险显著增加。
结论
在伴或不伴 Robin 序列的患者中，10 个月龄或之前行腭裂修复与二次手术风险增加相关。
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