Yang Shen, Liao Junmin, Li Siqi, Hua Kaiyun, Wang Peize, Zhang Yanan, Zhao Yong, Gu Yichao, Li Shuangshuang, Huang Jinshi
Department of Neonatal Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2021 Apr 27;9:634573. doi: 10.3389/fped.2021.634573. eCollection 2021.
This study aims to identify the risk factors and reasons for treatment abandonment for patients with esophageal atresia (EA) in a tertiary care hospital in China. A retrospective study was conducted on 360 patients with EA admitted to Beijing Children's Hospital between January 1, 2007 and June 1, 2020. Medical records for treatment abandonment and non-treatment abandonment patients were compared. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for treatment abandonment. After the diagnosis of EA, parents of 107 patients refused surgical repair and discharged against medical advice, and 253 patients underwent surgical repair. Among these 253 patients, parents of 59 patients abandoned treatment after surgery; 52 patients were discharged in an unstable condition, and parents of seven patients abandoned resuscitation leading to death in the hospital. By comparing clinical characteristics between treatment abandonment before surgery ( = 107) and non-treatment abandonment ( = 253) groups, we found that mother's parity >1, unplanned admission to intensive care unit before surgery, associated anomalies, and Gross type A/B were significant independent risk factors for treatment abandonment before surgery. Furthermore, birth weight <2,545 g, being discharged from neonatal center/intensive care unit and other departments, unplanned admission to intensive care unit after surgery, operative time >133 min, admission before 2016, pneumothorax, and anastomotic leakage were significant independent risk factors for treatment abandonment after surgery. The reasons for treatment abandonment included financial difficulties, multiple malformations with poor prognosis, belief of incurability and concerns about the prognosis of the diseases, postoperative complications, and extensive length of intensive care unit stay. Treatment abandonment of children with EA/TEF is still a common and serious problem in China. This study showed that EA/TEF patients in critical conditions, with associated anomalies, Gross type A/B, and who had occurrence of complications had high-risk for treatment abandonment.
本研究旨在确定中国一家三级医院中食管闭锁（EA）患者治疗放弃的风险因素及原因。对2007年1月1日至2020年6月1日期间收治于北京儿童医院的360例EA患者进行了一项回顾性研究。比较了治疗放弃患者和未放弃治疗患者的病历。进行单因素和多因素逻辑回归分析以确定治疗放弃的潜在风险因素。EA确诊后，107例患者的家长拒绝手术修复并自动出院，253例患者接受了手术修复。在这253例患者中，59例患者的家长在术后放弃治疗；52例患者出院时病情不稳定，7例患者的家长放弃复苏导致患者在医院死亡。通过比较术前治疗放弃组（n = 107）和未放弃治疗组（n = 253）的临床特征，我们发现母亲生育次数>1、术前意外入住重症监护病房、合并畸形以及A/B型大体分型是术前治疗放弃的显著独立风险因素。此外，出生体重<2545 g、从新生儿中心/重症监护病房及其他科室出院、术后意外入住重症监护病房、手术时间>133分钟、2016年前入院、气胸和吻合口漏是术后治疗放弃的显著独立风险因素。治疗放弃的原因包括经济困难、多种畸形且预后差、认为疾病无法治愈以及对疾病预后的担忧、术后并发症和在重症监护病房住院时间过长。在中国，EA/TEF患儿的治疗放弃仍然是一个常见且严重的问题。本研究表明，病情危急、合并畸形、A/B型大体分型以及发生并发症的EA/TEF患者治疗放弃风险高。
