Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, United States.
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, United States.
J Pediatr Surg. 2022 Mar;57(3):424-429. doi: 10.1016/j.jpedsurg.2021.05.021. Epub 2021 Jun 7.
BACKGROUND/PURPOSE: To assess surgical outcomes of patients with cerebral palsy (CP) and if they differ from patients without CP.
The NSQIP-Pediatric database from 2012 to 2019 was used to compare differences in presenting characteristics and outcomes between patients with and without CP. Chi-square tests and multivariable logistic regression analysis were used to determine significance.
119,712 patients, 433 (0.4%) with CP, 119,279 (99.6%) without, were identified. Patients with CP had more postoperative complications (19.4% vs. 6.9%, p < 0.001) with an OR of 3.2, (95%CI 2.5-4.1, p < 0.001) on univariable analysis. They underwent fewer laparoscopic procedures (79.1% vs. 90.8%, p < 0.001), had more readmissions (10.2% vs. 3.8%, p < 0.001), reoperations (5.1% vs. 1.2%, p < 0.001), and longer length of stays (LOS) (median 3 versus 1 day, p < 0.001). On multivariable analysis, having CP did not increase the odds of postoperative morbidity (OR 0.99, 95% CI 0.7-1.3), but higher ASA class, congenital lung malformation, gastrointestinal disease, coagulopathy, preoperative inotropic support, oxygen use, nutritional support, and steroid use significantly increase the odds of morbidity, all of which were more common in patients with CP.
Patients with CP have more postoperative complications, open procedures, and longer LOS. Patient complexity may account for these differences and risk-directed perioperative planning may improve outcomes.
Level IV.
背景/目的：评估脑瘫（CP）患者的手术结果，并比较其与无 CP 患者的结果是否存在差异。
使用 2012 年至 2019 年的 NSQIP-Pediatric 数据库，比较 CP 患者和无 CP 患者在表现特征和结果方面的差异。使用卡方检验和多变量逻辑回归分析确定差异的显著性。
共纳入 119712 例患者，其中 433 例（0.4%）为 CP 患者，119279 例（99.6%）为无 CP 患者。CP 患者术后并发症更多（19.4%比 6.9%，p<0.001），优势比为 3.2（95%CI 2.5-4.1，p<0.001）。CP 患者接受腹腔镜手术的比例更低（79.1%比 90.8%，p<0.001），术后再入院率更高（10.2%比 3.8%，p<0.001）、再手术率更高（5.1%比 1.2%，p<0.001），住院时间更长（中位数 3 天比 1 天，p<0.001）。多变量分析显示，CP 并不会增加术后发病率的几率（OR 0.99，95%CI 0.7-1.3），但更高的 ASA 分级、先天性肺畸形、胃肠道疾病、凝血障碍、术前正性肌力支持、氧疗、营养支持和类固醇使用显著增加发病率的几率，所有这些在 CP 患者中更为常见。
CP 患者术后并发症更多，采用开放手术，住院时间更长。患者的复杂性可能是导致这些差异的原因，针对风险的围手术期计划可能会改善结果。
IV 级。
