Williamson Catherine G, Verma Arjun, Tran Zachary K, Federman Myke D, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Division of Pediatric Critical Care, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA.
J Cardiothorac Vasc Anesth. 2022 Jan;36(1):208-214. doi: 10.1053/j.jvca.2021.03.008. Epub 2021 Mar 8.
Vocal fold paralysis (VFP) has proven to increase resource use in several surgical fields. However, its burden in congenital cardiac surgery, a specialty known to be associated with high resource use, has not yet been examined. The authors aimed to assess the impact of VFP on costs, lengths of stay, and readmissions following congenital cardiac surgery.
A retrospective analysis of administrative data.
The 2010-2017 National Readmissions Database.
All pediatric patients undergoing congenital cardiac surgery.
None.
Vocal fold paralysis was defined using International Classification of Diseases, Ninth and Tenth Revisions, diagnosis codes. The primary outcome of interest was 30-day nonelective readmissions and 90-day readmissions; costs, length of stay, and discharge status also were considered. Of an estimated 124,486 patients meeting study criteria, 2,868 (2.3%) were identified with VFP. Incidence of VFP increased during the study period (0.7% in 2010 to 3.2% in 2017, nptrend < 0.001). Rates of nonhome discharge (30.0% v 16.4%, p < 0.001), 30-day readmission (23.9% v 12.4%, p < 0.001), and 90-day readmission (8.3% v 4.4%, p = 0.03) were increased in the VFP cohort, as were lengths of stay (42.1 v 27.0 days, p < 0.001) and costs ($196,000 v $128,000, p < 0.001). After adjustment for patient and hospital factors, VFP was independently associated with greater odds of nonhome discharge (adjusted odds ratios [AOR], 1.66, 95% CI, 1.14-2.40), 30-day readmission (AOR, 1.58, 95% CI, 1.03-2.42), 90-day readmission (AOR, 2.07, 95% CI, 1.22-3.52), longer lengths of stay (+ 6.1 days, 95% CI, 1.3-10.8), and higher hospitalization costs (+$22,000, 95% CI, 3,000-39,000).
Readmission rates after congenital cardiac surgery are significantly greater among those with VFP, as are costs, lengths of stay, and nonhome discharges. Therefore, further efforts are necessary to increase awareness and reduce the incidence of VFP in this vulnerable population to minimize the financial burden of congenital cardiac surgery on the US medical system.
事实证明，声带麻痹（VFP）会增加多个外科领域的资源使用。然而，其在先天性心脏手术（一个已知资源使用量很高的专科领域）中的负担尚未得到研究。作者旨在评估VFP对先天性心脏手术后的成本、住院时间和再入院情况的影响。
对行政数据进行回顾性分析。
2010 - 2017年国家再入院数据库。
所有接受先天性心脏手术的儿科患者。
无。
使用国际疾病分类第九版和第十版的诊断代码来定义声带麻痹。主要关注的结果是30天非选择性再入院和90天再入院；同时也考虑了成本、住院时间和出院状态。在估计符合研究标准的124,486名患者中，有2,868名（2.3%）被确诊为VFP。在研究期间，VFP的发病率有所上升（从2010年的0.7%升至2017年的3.2%，趋势检验p值<0.001）。VFP队列中的非回家出院率（30.0%对16.4%，p<0.001）、30天再入院率（23.9%对12.4%，p<0.001）和90天再入院率（8.3%对4.4%，p = 0.03）均有所增加，住院时间（42.1天对27.0天，p<0.001）和成本（196,000美元对128,000美元，p<0.001）也更高。在对患者和医院因素进行调整后，VFP与非回家出院的更高几率（调整后的优势比[AOR]为1.66，95%置信区间[CI]为1.14 - 2.40）、30天再入院（AOR为1.58，95%CI为1.03 - 2.42）、90天再入院（AOR为2.07，95%CI为1.22 - 3.52）、更长的住院时间（增加6.1天，95%CI为1.3 - 10.8）以及更高的住院成本（增加22,000美元，95%CI为3,000 - 39,000）独立相关。
先天性心脏手术后，VFP患者的再入院率、成本、住院时间和非回家出院率显著更高。因此，有必要进一步努力提高对这一脆弱人群中VFP的认识并降低其发病率，以尽量减少先天性心脏手术对美国医疗系统的经济负担。
